RESUMEN
BACKGROUND: Clinical evidence suggests an association between preterm birth and periodontal disease. This study explores whether specific genetic polymorphisms are associated with success of periodontal therapy in pregnant women with periodontal disease and, further, whether any of these same polymorphisms are also associated with spontaneous preterm birth (sPTB). METHODS: One hundred sixty high-risk pregnant women (6 to 20 weeks of gestation) with periodontal disease (≥ 3 sites with attachment loss ≥ 4 mm) were studied. All women received scaling and root planing plus oral hygiene instruction. Periodontal examinations were performed before treatment and 20 weeks later. Participants were classified according to two study outcomes: 1) success or failure of periodontal treatment; and 2) presence or absence of sPTB. Maternal DNA samples from mucosal swabs were characterized using a 1536-SNP (single-nucleotide polymorphism) custom polymerase chain reaction chip. A probabilistic model of each dichotomous outcome, derived using a stepwise Bayesian procedure, was compared to respective null hypotheses on the basis of Monte Carlo simulations and significance estimates obtained using three measures (z-test, Welch t-test, and probability convolution). The models were further confirmed by logistic regression analyses. RESULTS: The models revealed a significant relation between a specific polymorphism of prostaglandin E receptor 3 (a gene associated with inflammatory response) and both periodontal treatment failure (odds ratio 11.09, P <0.0002) and sPTB (odds ratio 6.89, P < 0.0032). CONCLUSIONS: These results demonstrate that the risk of unsuccessful periodontal treatment is associated with tag SNPs in specific genes that regulate the inflammatory response, one of which is also associated with sPTB.
Asunto(s)
Enfermedades Periodontales/terapia , Resultado del Embarazo , Nacimiento Prematuro , Subtipo EP3 de Receptores de Prostaglandina E/genética , Adolescente , Adulto , Teorema de Bayes , Raspado Dental/métodos , Femenino , Frecuencia de los Genes/genética , Variación Genética/genética , Genotipo , Gingivitis/terapia , Humanos , Método de Montecarlo , Higiene Bucal/educación , Pérdida de la Inserción Periodontal/terapia , Índice Periodontal , Periodontitis/terapia , Polimorfismo de Nucleótido Simple/genética , Embarazo , Factores de Riesgo , Aplanamiento de la Raíz/métodos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Limited information comparing digital subtraction radiographic assessment with conventional radiographic interpretation is available from longitudinal clinical trials. The aim of this study was to evaluate the ability to detect periodontal bone changes during the long-term maintenance of Class II furcation defects by conventional radiographic interpretation compared to interpretation of digital subtraction images. METHODS: Standardized radiographs of 18 Class II furcation defects in mandibular molars were taken at baseline and at 6, 12, 18, and 24 months after non-resective periodontal surgery. Conventional radiographic and digital subtraction interpretations were performed masked, respectively, by two and three experienced examiners, according to the following categories: bone gain; bone loss; unchanged appearance; and impossible to visualize. Percent concordance and the kappa statistic value (kappa) were computed. RESULTS: Conventional radiographic and digital subtraction interpretation images resulted in 72 decisions for each examiner. The visual interpretation of digital subtraction images by two examiners revealed the same results. The interpretation of conventional radiographic images showed a low concordance between examiners (kappa < 0.40) at all examinations. The concordance between subtraction radiography and conventional radiographic interpretation was also low for all examiners (kappa < 0.36) at all examinations. Using subtraction radiography as a reference, bone changed and bone unchanged were diagnosed correctly in 47.2% of cases by examiner A, in 43.1% by examiner B, and in 38.9% by examiner C. CONCLUSION: It can be concluded that conventional radiographic interpretation is a more subjective and inaccurate method of detecting periodontal bone changes in Class II furcation defects in mandibular molars when compared with subtraction radiography.
Asunto(s)
Pérdida de Hueso Alveolar/diagnóstico por imagen , Defectos de Furcación/diagnóstico por imagen , Radiografía Dental/métodos , Pérdida de Hueso Alveolar/cirugía , Estudios de Seguimiento , Defectos de Furcación/cirugía , Humanos , Variaciones Dependientes del Observador , Intensificación de Imagen Radiográfica , Radiografía de Mordida Lateral , Radiografía Dental Digital , Técnica de SustracciónRESUMEN
PURPOSE: To evaluate the treatment outcomes after guided tissue regeneration (GTR) with a bioabsorbable membrane in Class II furcation defects in mandibular molars. The open flap debridement (OFD) was used as the control. METHODS: Nine patients, with two comparable Class II furcation defects were included in the study. After initial preparation, the defects were randomly assigned in each patient to either GTR-group or OFD-group. Clinical parameters and standardized radiographs were obtained at baseline and 6 months after the surgeries. The radiographs were analyzed by subtraction radiography. RESULTS: Comparing baseline to 6-month results, both groups showed statistically significant probing depth reduction (PD), horizontal clinical attachment level (CAL-h) gain, and increase in gingival recession (GR). The vertical clinical attachment level (CAL-v) gain was statistically significant only for the OFD-group. Comparing the two treatments, no statistically significant differences were found in PD reduction (GTR: 1.67 mm; OFD: 2.51 mm, P = 0.26), CAL-v gain (GTR: 0.62 mm; OFD: 1.16 mm, P= 0.37), and GR increase (GTR: 1.04 mm; OFD: 1.24 mm, P = 0.31). GTR provided complete closure of the furcation defect in two sites and superior horizontal clinical attachment level gain (GTR: 2.27 mm; OFD: 1.01 mm, P = 0.05). Subtraction radiography showed significant difference in bone height change between GTR-group and OFD-group (-0.14 mm and 0.86 mm, respectively; P = 0.028) at 6 months.