Utilização de proteinas derivadas da matriz do esmalte (EMDOGAIN) no tratamento de defeitos intra-osseos : estudo longitudinal clinico e radiografico

Orientador: Sergio de ToledoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O objetivo do presente estudo foi comparar através de parâmetros clínicos e radiográficos o tratamento cirúrgico de defeitos periodontais intra-ósseos com ou sem a utilização de um gel composto por proteínas derivadas da matriz do esmalte (EMDOGAIN ¿MARCA REGISTRADA¿. Quinze pacientes, apresentando um total de 19 defeitos intra-ósseos interproximais compostos por 1 ou 2 paredes ósseas em dentes unirradiculares, foram divididos aleatoriamente nos grupos teste e controle. Os parâmetros clínicos foram avaliados através de guias de sondagem - stents, antes do procedimento cirúrgico (baseline), com 6 e 18 meses de pós-operatório, sendo eles: posição da margem gengival relativa (PMGR), nível de inserção clínica relativo (NICR) e profundidade de sondagem (PS). Medidas radiográficas lineares foram obtidas nos mesmos períodos de avaliação, através de radiografias padronizadas e digitais. Os dados foram analisados estatisticamente usando ANOVA e o teste de Tukey (p< 0,05). Os resultados clínicos mostraram que aos 18 meses de avaliação houve, em média, uma redução da profundidade de sondagem de 3,2 '+ ou -' 1,44mm e um ganho no nível de inserção de 1,4 '+ ou - ' 1,26mm para o grupo teste, enquanto que no grupo controle, o valor médio de redução da profundidade de sondagem foi de 2,7 :t 0,89mm e do ganho de inserção clínica foi de 1,2 '+ ou -' 0,78mm. Radiograficamente, houve um preenchimento ósseo médio de 1,64 '+ ou -' 1,69mm no grupo teste e de 0,71 '+ ou -' 1,90mm no grupo controle. Os dois tratamentos cirúrgicos melhoraram os parâmetros clínicos e radiográficos quando comparados ao baseline, mas a diferença encontrada entre os grupos não foi estatisticamente significante. Portanto, pode-se concluir que o tratamento cirúrgico convencional e regenerativo têm efeitos favoráveis na redução da profundidade de sondagem, no ganho clínico de inserção e no preenchimento ósseo radiográfico após 18 meses de avaliação. Um estudo envolvendo uma amostra de tamanho maior é necessário para confirmar essa equivalência estatística entre as duas modalidades de tratamentoAbstract: The aim of the present study was to compare the clinical and radiographical effects of the treatment of intrabony periodontal defects with or without the use of a gel composed of enamel matrix proteins derivative (EMDOGAIN 'TRADEMARK¿). Fifteen patients, exhibiting a total of 19 defects 1 and 2 wall intrabony defects on one-rooted teeth, were randomly divided into test and control groups. Prior to surgery (baseline), 6 and 18 months after it the following parameters were evaluated using oclusal stents: relative gingival recession (RGR), relative clinical attachment levei (RCAL) and probing depth (PD). Linear radiographic measurements were obtained at the same time during this period through standard digital radiographies. Data were statistically analyzed using ANOVA and Tukey's Studentized Range Test (p< 0,05). The clinical results demonstrated that after 18 months there was a reduction in probing depth of 3.2 : '+ or -' 1.44mm and a gain in the clinical attachment levei of 1.4 '+ or -' 1.26mm on average for the test group. As for the control group the reduction in the probing depth was of 2.7 '+ or -' 0.89mm and the gain in the clinical attachment levei was of 1.2 '+ or -' 0.78mm on average. Radiographically, there was an average bone filling of 1.64'+ or -' 1.69mm in the test group and 0.7 '+ or -' 1.9mm in the control group. The two treatments improved clinical parameters as compared to baseline, but the differences found between the groups were not statistically significant. Therefore, it may be concluded that both therapies have similar effects in promoting probing depth reduction, clinical attachment gain, and defect bone till in the 18th month post treatment. A study involving a larger sample size is necessary to statistically confirm the equivalence between the two treatment modalitiesDoutoradoPeriodontiaDoutor em Clínica Odontológic

Utilização de proteinas derivadas da matriz do esmalte (EMDOGAIN) no tratamento de defeitos intra-osseos : estudo clinico e radiografico

Orientador: Sergio de ToledoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O objetivo do presente estudo foi comparar, clínica e radiograficamente, o tratamento cirúrgico de defeitos periodontais intra-ósseos com ou sem a utilização de um gel composto por proteínas derivadas da matriz do esmalte (EMDOGAIN@). Dezessete pacientes, apresentando um total de 21 defeitos intra-ósseos interproximais compostos por predominantemente 1 ou 2 paredes ósseas em dentes unirradiculares, foram divididos aleatoriamente nos grupos teste e controle. Os parâmetros clínicos foram avaliados através de aparelhos orientadores de sondagem - stents, antes do procedimento cirúrgico (baseline) e com 6 meses de pós-operatório, sendo eles: posição da margem gengival (PMG), nível de inserção clínica relativo (NICR) e profundidade de sondagem (PS). Paralelamente, também foram feitas nos mesmos períodos de avaliação, radiografias padronizadas e digitais que foram avaliadas por subtração radiográfica. Clinicamente, tanto para o grupo teste quanto para o grupo controle, houve uma redução significativa dos parâmetros clínicos após o tratamento (p::;; 0,001). Entretanto, essas reduções não foram estatisticamente diferentes entre o grupo teste e controle (p _ 0,001). A avaliação por subtração radiográfica identificou áreas de ganho e de perda de densidade óssea radiográfica em percentual da área total do defeito, no período de 6 meses de pós-operatório, de modo que, a comparação entre os grupos não revelou diferenças estatísticas. Entretanto, a comparação intra-grupo entre ganho e perda de densidade óssea radiográfica revelou que a utilização das proteínas derivadas da matriz do esmalte resultou em mais ganho do que perda de densidade óssea radiográfica (p ::;; 0,001). Desta forma, dentro dos limites do presente trabalho, a utilização de proteínas derivadas da matriz do esmalte pode promover benefícios no tratamento de defeitos intra-ósseosAbstract: The aim of the present study was to compare, clinically and radiographically, the treatment of intrabony periodontal defects with or without the use of a gel composed of enamel matrix proteins derivative (EMDOGAIN@). Seventeen patients, exhibiting a total of 21 defects predominantly 1 or 2 wall intrabony defects on one-rooted teeth, were randomly divided into test and control groups. Prior to surgery (baseline) and 6 months later the following parameters were evaluated using oclusal stents: gingival recession (GR), relative clinical attachment level (CAL) and probing depth (PD). At the same time during this period, standard digital radiographies were made and evaluated through subtraction radiography. Clinically, both for the test and control groups there was a significant reduction of the clinical parameters afier the treatment (p ::; 0,001). However, these reductions were not statistically different between the test and control groups (p _ 0,001). The subtraction radiography identified gain and loss areas of bony radiographic density in percentage terms of the total area of the defect within 6 months afier the surgery, as a result the comparison between the groups has not shown any statistic differences. However, the intra-group comparison between gain and loss areas of radiographic density has revealed that the use of enamel matrix proteins derivative has led to more gain than loss of radiographic density. In conclusion, within the limits of the present study the use of enamel matrix proteins derivative can promote benefits in the treatment of intrabony defectsMestradoPeriodontiaMestre em Clínica Odontológic

Effect of cetylpyridinium chloride with xylitol on the formation of biofilm and development of gingivitis

Aim: To assess the effect of the combination of cetylpyridinium chloride and xylitol on the formation of dental biofilm and development of experimental gingivitis. Methods: A crossover, double-blind, placebo-controlled study was conducted and divided into two phases of 21 days each with a time interval of 10 days between them. A modified experimental gingivitis model was used and 31 volunteers were randomly divided into 2 groups. The volunteers performed daily mouthwashes twice a day with the test solution containing cetylpyridinium combined with xylitol or a placebo solution. On day 0 and day 21 of each phase the Plaque Index (PI) and Gingival Index (GI) of each volunteer were measured. During this phase, the volunteers brushed their teeth with standard toothbrushes and dentifrice, protecting the third quadrant with a toothshield. After brushing, the toothshield was removed and the mouthwash was used. Results: The PI values observed in the Test Group at baseline and on day 21 were 0 (0.00 – 0.03) and 0 (0.22-0.48) respectively, and in Control Group 0 (0.00 – 0.03) and 1 (0.45 – 0.81) (inter-group analysis - McNemar test, p<0.05). For GI, the values obtained in the Test Group were 0 (0.00 – 0.03) and 1 (0.48 – 0.71), at baseline and day 21 and in Control Group 0 (0.00 – 0.03) and 1 (0.58 – 0.84) (inter-group analysis - McNemar test, p>0.05). Conclusions: The test solution had a positive effect on dental biofilm control. However, it was not capable of preventing the development of experimental gingivitis

Effect of cetylpyridinium chloride with xylitol on the formation of biofilm and development of gingivitis

assess the effect of the combination of cetylpyridinium chloride and xylitol on the formation of dental biofilm and development of experimental gingivitis. Methods: A crossover, double-blind, placebo-controlled study was conducted and divided into two phases of 21 days each with a time interval of 10 days between them. A modified experimental gingivitis model was used and 31 volunteers were randomly divided into 2 groups. The volunteers performed daily mouthwashes twice a day with the test solution containing cetylpyridinium combined with xylitol or a placebo solution. On day 0 and day 21 of each phase the Plaque Index (PI) and Gingival Index (GI) of each volunteer were measured. During this phase, the volunteers brushed their teeth with standard toothbrushes and dentifrice, protecting the third quadrant with a toothshield. After brushing, the toothshield was removed and the mouthwash was used. Results: The PI values observed in the Test Group at baseline and on day 21 were 0 (0.00 0.03) and 0 (0.22-0.48) respectively, and in Control Group 0 (0.00 0.03) and 1 (0.45 0.81) (inter-group analysis - McNemar test, p0.05). Conclusions: The test solution had a positive effect on dental biofilm control. However, it was not capable of preventing the development of experimental gingivitis