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PURPOSE: In this study, we examined the facial, dental, periodontal, and tomographic features associated with excessive gingival display (EGD) when smiling in young adults self-reporting a "gummy smile," categorized by potential etiology. METHODS: The study included 25 healthy adults (18-42 years old; 23 women and 2 men) who self-reported EGD. Participants completed a health questionnaire and underwent a periodontal examination assessing probing depth, clinical attachment level, keratinized gingival width, and gingival thickness (GT). Extraoral and intraoral photographs were taken for smile analysis and to determine facial and dental characteristics. Cone-beam computed tomography (CBCT), performed with a lip retractor in place, was used to measure the distance from the gingival margin (GM) to the cementoenamel junction (CEJ), the distance from the CEJ to the alveolar crest, buccal bone thickness, and GT. The extent of EGD when smiling was quantified as the distance from the GM at the upper central incisor to the upper lip edge when smiling fully. The smile was categorized into 4 types based on gingival exposure characteristics observed during full smile. RESULTS: Most participants were female (92%), with a mean age of 28.77±6.56 years. The average EGD was 4.2±2.44 mm, extending bilaterally from the anterior to the posterior maxilla. Two primary etiological factors were identified, alone or in combination: vertical maxillary excess (VME), predominantly indicated by an anterior maxillary height greater than 29 mm and a large interlabial gap; and altered passive/active eruption (APE), primarily characterized by square teeth (64%), upper central incisor width-to-height ratio (CIW:CIH) exceeding 87.5%, and GM-CEJ distance on CBCT exceeding 2 mm. CONCLUSIONS: These findings suggest a multifactorial etiology of EGD, primarily associated with VME and APE. Clinical periodontal examination, CBCT conducted with a lip retractor, CIW:CIH, and soft tissue facial cephalometric analysis may aid in identifying the etiological factors of EGD.
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Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease characterized by tissue damage and widespread inflammation in response to environmental challenges. Deposition of immune complexes in kidneys glomeruli are associated with lupus nephritis, determining SLE diagnosis. Periodontitis is a chronic inflammatory disease characterized by clinical attachment and bone loss, caused by a microbial challenge - host response interaction. Deposition of immune complex at gingival tissues is a common finding in the course of the disease. Considering that, the primary aim of this study is to investigate the deposition of immune complexes at gingival tissues of SLE patients compared to systemically healthy ones, correlating it to periodontal and systemic parameters. Twenty-five women diagnosed with SLE (SLE+) and 25 age-matched systemically healthy (SLE-) women were included in the study. Detailed information on overall patient's health were obtained from file records. Participants were screened for probing depth (PD), clinical attachment loss (CAL), gingival recession (REC), full-mouth bleeding score (FMBS) and plaque scores (FMPS). Bone loss was determined at panoramic X-ray images as the distance from cementenamel junction to alveolar crest (CEJ-AC). Gingival biopsies were obtained from the first 15 patients submitted to surgical periodontal therapy of each group, and were analyzed by optical microscopy and direct immunofluorescence to investigate the deposition of antigen-antibody complexes. Eleven (44%) patients were diagnosed with active SLE (SLE-A) and 14 (56%) with inactive SLE (LES-I). Mean PD, CAL and FMBS were significantly lower in SLE+ than SLE-(p < 0.05; Mann Whitney). The chronic use of low doses of immunosuppressants was associated with lower prevalence of CAL >3 mm. Immunofluorescence staining of markers of lupus nephritis and/or proteinuria was significantly increased in SLE+ compared to SLE-, even in the presence of periodontitis. These findings suggest that immunomodulatory drugs in SLE improves periodontal parameters. The greater deposition of antigen-antibody complexes in the gingival tissues of patients diagnosed with SLE may be a marker of disease activity, possibly complementing their diagnosis.
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Complexo Antígeno-Anticorpo/imunologia , Suscetibilidade a Doenças , Gengiva/imunologia , Lúpus Eritematoso Sistêmico/etiologia , Periodontite/etiologia , Adulto , Complexo Antígeno-Anticorpo/metabolismo , Biomarcadores , Comorbidade , Gerenciamento Clínico , Feminino , Imunofluorescência , Humanos , Imuno-Histoquímica , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/metabolismo , Masculino , Pessoa de Meia-Idade , Periodontite/diagnóstico , Periodontite/epidemiologia , Periodontite/metabolismo , Fatores de Risco , Índice de Gravidade de Doença , Adulto JovemRESUMO
The purposes of this study are to evaluate the effects of photobiomodulation (PBM) with laser and LED on rat calvaria osteoblasts (rGO lineage), cultured in osteogenic (OST) or regular (REG) medium, after induction of a quiescent state and to test if PBM is capable of osteogenic induction and if there is a sum of effects when combining OST medium with PBM. Before irradiation, the cells were put in a quiescent state (1% FBS) 24 h, when red (AlGaInP-660 nm) and infrared laser (GaAlAs-808 nm) and LED (637 ± 15 nm) were applied. The groups were as follows: red laser (RL3-5 J/cm2, 3 s and RL5-8.3 J/cm2, 5 s, 1.66 W/cm2); infrared laser (IrL3-5 J/cm2, 3 s and IrL5-8.3 J/cm2, 5 s); LED (LED3-3 s and LED5-5 s, 0.02 J/cm2, 0.885 W/cm2); positive (C+, 10% FBS) and negative control (C-, 1% FBS). For alkaline phosphatase (ALP) and mineralization assays, the cells were cultured in REG (DMEM 10% FBS) and OST medium (DMEM 10% FBS, 50 µg/mL ascorbic acid, 10 mM ß-glycerophosphate). Statistical analysis was performed using ANOVA and Tukey's tests (p < 0.05). RL5 and LED5 increased proliferation, in vitro wound closure, ALP, and mineralization in rGO cells (p < 0.05). PBM with red laser and LED induced mineralization by itself, without osteogenic medium, not observed for infrared laser (p < 0.05). A sum of effects was observed in osteogenic medium and PBM by infrared, red laser, and LED (5 s). Red laser and LED increased proliferation, migration, and secretory phases in rGO cells in a dose-dependent manner. PBM with red laser and LED promotes osteogenic induction by itself. PBM with infrared laser and osteogenic medium potentializes mineralization.
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Lasers , Terapia com Luz de Baixa Intensidade , Osteoblastos/efeitos da radiação , Osteogênese/efeitos da radiação , Crânio/efeitos da radiação , Fosfatase Alcalina/metabolismo , Animais , Calcificação Fisiológica/efeitos da radiação , Diferenciação Celular/efeitos da radiação , Proliferação de Células/efeitos da radiação , Sobrevivência Celular/efeitos da radiação , Células Cultivadas , RatosRESUMO
BACKGROUND: This split-mouth randomized clinical trial compared two different types of subepithelial connective tissue grafts (SCTG) considering clinical parameters and patient-centered outcomes in patients with bilateral recession type 1 multiple gingival recessions after 6 months postoperatively. METHODS: A total of 21 patients were surgically treated with coronally advanced flap (CAF) associated with SCTG harvested by: double blade scalpel (DBS) and de-epithelialized (DE) SCTG. Periodontal clinical parameters and esthetics were evaluated by a calibrated periodontist at baseline and after 6 months. Patient-centered outcomes related to pain/discomfort and esthetics were assessed with visual analogue scale after 7 days and 6 months, respectively. RESULTS: All clinical parameters, with the exception of probing depth, demonstrated differences in intragroup evaluation, comparing baseline to 6-month evaluation (P <0.05). Both groups presented reduction of recession depth and recession width and gain of keratinized tissue thickness, keratinized tissue width, and clinical attachment level (P <0.05). Intergroup comparison (DBS × DE) demonstrated no significant differences considering clinical parameters and periods. Both techniques improved esthetics evaluated by patients, without a difference between groups in patients and professional analysis. However, DBS group presented inferior pain/discomfort compared with DE (P <0.05). CONCLUSION: DBS and DE associated with CAF presented satisfactory clinical outcomes. However, DBS presented inferior morbidity, an important fact for decision-making process.
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Tecido Conjuntivo , Retração Gengival , Tecido Conjuntivo/transplante , Estética Dentária , Gengiva/cirurgia , Retração Gengival/cirurgia , Humanos , Boca , Assistência Centrada no Paciente , Raiz Dentária , Resultado do TratamentoRESUMO
Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease characterized by tissue damage and widespread inflammation in response to environmental challenges. Deposition of immune complexes in kidneys glomeruli are associated with lupus nephritis, determining SLE diagnosis. Periodontitis is a chronic inflammatory disease characterized by clinical attachment and bone loss, caused by a microbial challenge host response interaction. Deposition of immune complex at gingival tissues is a common finding in the course of the disease. Considering that, the primary aim of this study is to investigate the deposition of immune complexes at gingival tissues of SLE patients compared to systemically healthy ones, correlating it to periodontal and systemic parameters. Twenty-five women diagnosed with SLE (SLE+) and 25 age-matched systemically healthy (SLE) women were included in the study. Detailed information on overall patient's health were obtained from file records. Participants were screened for probing depth (PD), clinical attachment loss (CAL), gingival recession (REC), full-mouth bleeding score (FMBS) and plaque scores (FMPS). Bone loss was determined at panoramic X-ray images as the distance from cementenamel junction to alveolar crest (CEJ-AC). Gingival biopsies were obtained from the first 15 patients submitted to surgical periodontal therapy of each group, and were analyzed by optical microscopy and direct immunofluorescence to investigate the deposition of antigen-antibody complexes. Eleven (44%) patients were diagnosed with active SLE (SLE-A) and 14 (56%) with inactive SLE (LES-I). Mean PD, CAL and FMBS were significantly lower in SLE+ than SLE(p < 0.05; Mann Whitney). The chronic use of low doses of immunosuppressants was associated with lower prevalence of CAL >3 mm. Immunofluorescence staining of markers of lupus nephritis and/or proteinuria was significantly increased in SLE+ compared to SLE, even in the presence of periodontitis. These findings suggest that immunomodulatory drugs in SLE improves periodontal parameters. The greater deposition of antigen-antibody complexes in the gingival tissues of patients diagnosed with SLE may be a marker of disease activity, possibly complementing their diagnosis.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Gengiva/imunologia , Lúpus Eritematoso Sistêmico/etiologia , Complexo Antígeno-Anticorpo/imunologia , Periodontite/etiologia , Suscetibilidade a DoençasRESUMO
PURPOSE: To investigate the influence of implant surface decontaminated and uncontaminated on osteoblast-like cell adhesion and proliferation MATERIALS AND METHODS: Commercially available implants of different brands and surface characteristics were selected: Biomet 3i® Nanotite (NT) and Osseotite (OT), Straumann® SLActive (SLA), and Neodent® Acqua Drive (ACQ) and Neoporos Drive CM (CM). Physical and chemical properties of the implants were investigated by scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), and wettability analysis (WETT). Implants were previously contaminated with Aggregatibacter actinomycetemcomitans strains; after that, samples were decontaminated by different chemical methods. Decontaminated (test group; n = 15/type of implant) and uncontaminated (control group; n = 5/type of implant) samples were analyzed according to the number of human osteoblastic osteosarcoma cells (Saos-2) adhered on the implant surface after 24 h and 72 h in SEM images. RESULTS: ACQ was found to be highly hydrophilic, and NT was the most hydrophobic implant. Increased variation of Saos-2 cell adhesion and proliferation were observed on all test and control groups. Controversially, at the proliferation analysis in 72 h, CM implant was the only implant that showed no significant difference between test and group (p = 0.2833; Tukey's multiple comparisons test). NT implants showed the greater value of cell proliferation when compared with all types of implant surface (p = 0.0002; Tukey's multiple comparisons test). CONCLUSIONS: These findings suggest that decontaminated surfaces were able to impair the counting of osteoblast-like cell adhesion and proliferation.
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OBJECTIVES: This study evaluated clinical outcomes of acellular dermal matrix (ADM) allograft compared with autogenous free gingival graft (FGG) for gingival augmentation after 15 years. MATERIAL AND METHODS: Twenty-two patients were originally included and evaluated by de Resende et al. (Clin Oral Investig 23:539-550, 2019), and 12 accepted to participate in this longitudinal evaluation. Clinical parameters evaluated were recession depth (RD), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), and soft tissue thickness (TT). In addition, esthetic perception was evaluated by patients and by a calibrated periodontist. Data were evaluated by ANOVA complemented by Tukey tests (p < 0.05). RESULTS: After 15 years, both treatments provided a significant increase in KTW and TT but with superior results for the FGG group (p < 0.05). No differences were observed between groups for PD and CAL. In the ADM group, RD significantly increased in long term, as well as the rate of tissue contraction. The percentage of shrinkage for the ADM group was 59.6%. Conversely, the FGG group presented a creeping attachment of 17.6% and RD significantly decreased in long term. The ADM group presented superior results considering professional esthetic perception. CONCLUSIONS: Both treatments longitudinally promoted significant gain of keratinized tissue width and thickness with superior outcomes for the FGG group. The ADM group demonstrated more tissue contraction and gingival recession whereas the FGG group presented creeping attachment. Professional esthetic perception was superior for the ADM group. CLINICAL RELEVANCE: This study added important clinical data with long-term evaluation of ADM compared with FGG.
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Derme Acelular , Gengiva/transplante , Retração Gengival/cirurgia , Procedimentos Cirúrgicos Bucais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Background: The aim of this study was to evaluate the cytotoxicity of cyanoacrylate adhesives in an indirect contact assay in human gingival fibroblast (FGH) and oral osteoblasts (GO) lineages. Methods: Cover glasses were glued with adhesives following the ISO 10993-2012 protocol. The groups were: C (control with cells and regular Dulbecco Modified Eagle Medium; LC (liquid ethyl-cyanoacrylate); GC (ethyl-cyanoacrylate gel); EGC (easy gel [ethyl-cyanoacrylate]); and D (Dermabond [octyl-cyanoacrylate]). Each cell linage was plated in the sixth passage using 104 cells. Cell viability was measured by the MTT test at 24, 48, 72, and 96 hours. Data were analyzed by two-way analysis of variance complemented by the Tukey test, with p < 0.05 being significant. Results: Dermabond stimulated osteoblast viability at 72 h (p < 0.05). All other groups were similar to the control cells (p > 0.05). For the fibroblasts, there was no difference in the groups, including the control except that EGC was cytotoxic for these cells (p < 0.05). Conclusions: Ethyl-cyanoacrylate gel and liquid forms available on the general chemical market were not cytotoxic for oral osteoblasts and fibroblasts in most cases. However, the easy gel form was cytotoxic for fibroblasts.
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Acetatos/toxicidade , Fibroblastos/efeitos dos fármacos , Gengiva/efeitos dos fármacos , Osteoblastos/efeitos dos fármacos , Adesivos Teciduais/toxicidade , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Gengiva/citologia , HumanosRESUMO
The importance of surgical intervention for the maintenance of long-term results by root coverage of multiple gingival recessions in an esthetic area treated with a tissue substitute (acellular dermal matrix [ADM]-Alloderm®) is widely required. The present case report highlights the effectiveness of the ADM for the treatment of multiple recession defects in a female patient with Class I and II gingival recession in relation to maxillary anterior associated with esthetics and dentin hypersensitivity demands. The root coverage rate for the anterior area showed greater value with 70% of coverage; at 90 days and 2 and 12 years of follow-up, it showed 70.5%, 79%, and 77%, respectively. Conversely, for the posterior area, these rates were 68.5%, 63%, and 57% for the same follow-up periods. Results regarding gain of keratinized tissue demonstrated superior values for the anterior area, namely 3.92, 3.34 and 3.22 mm at 90 days and 2 and 12 years. These values for the posterior area were 0.54 mm, 2.41, and 1.87 mm, respectively. These findings suggest that the tissue substitute Alloderm® showed excellent long-term results for areas of multiple recessions, providing root coverage and stability of keratinized tissue gain. After this long period of evaluation, some local factors associated with recurrence of gingival recessions were detected, and a lack of proper periodontal maintenance care was observed. However, esthetic and functional outcomes achieved with surgical procedure were maintained.
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OBJECTIVES: This split-mouth controlled randomized clinical trial evaluated clinical and histological results of acellular dermal matrix allograft (ADM) compared to autogenous free gingival graft (FGG) for keratinized tissue augmentation. MATERIAL AND METHODS: Twenty-five patients with the absence or deficiency of keratinized tissue (50 sites) were treated with FGG (control group) and ADM (test group). Clinical parameters included keratinized tissue width (KTW) (primary outcome), soft tissue thickness (TT), recession depth (RD), probing depth (PD), and clinical attachment level (CAL). Esthetic perception was evaluated by patients and by a calibrated periodontist using visual analog scale (VAS). Histological analysis included biopsies of five different patients from both test and control sites for each evaluation period (n = 25). The analysis included percentage of connective tissue components, epithelial luminal to basal surface ratio, tissue maturation, and presence of elastic fibers. Data were evaluated by ANOVA complemented by Tukey's tests (p < 0.05). RESULTS: After 6 months, PD and CAL demonstrated no differences between groups. ADM presented higher RD compared to FGG in all periods. Mean tissue shrinkage for control and test groups was 12.41 versus 55.7%. TT was inferior for ADM group compared to FGG. Esthetics perception by professional evaluation showed superior results for ADM. Histomorphometric analysis demonstrated higher percentage of cellularity, blood vessels, and epithelial luminal to basal surface ratio for FGG group. ADM group presented higher percentage of collagen fibers and inflammatory infiltrate. CONCLUSIONS: Both treatments resulted in improvement of clinical parameters, except for RD. ADM group presented more tissue shrinkage and delayed healing, confirmed histologically, but superior professional esthetic perception. CLINICAL RELEVANCE: This study added important clinical and histological data to contribute in the decision-making process between indication of FGG or ADM.
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Derme Acelular , Gengiva/transplante , Retração Gengival/cirurgia , Gengivoplastia/métodos , Adulto , Biópsia , Estética Dentária , Feminino , Humanos , Masculino , Índice Periodontal , Resultado do TratamentoRESUMO
Subepithelial connective tissue graft (SCTG) presents favorable outcomes. However, the harvesting technique can influence the anatomical and histological composition of the SCTG. Within the limitations of a case report, the behavior of SCTGs removed by two techniques was evaluated bilaterally in one patient using double blade scalpel (DBS) and de-epithelialized graft (DE). Clinical parameters, laser Doppler flowmetry (LDF) and histological analysis were assessed. Complete root coverage was observed bilaterally, as well as improvement in width and thickness of keratinized tissue 2 years postoperatively. The LDF analysis demonstrated better revascularization in the DBS recipient area compared to DE. The histological evaluation showed differences in tissue composition and organization of collagen fibers. Similar clinical outcomes were observed bilaterally, nevertheless greater morbidity and aesthetic was reported in the DE harvesting area.
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Objetivo: revisar a literatura sobre o tratamento dasdoenças periodontais associado a probióticos, identificandoas funcionalidades e os principais agentes microbianosempregados. Material e método: foi realizadabusca nas bases de dados eletrônicas PubMed e ScienceDirect, empregando os termos de busca probiotics eperiodontal diseases. Como critérios de inclusão, foramselecionadas pesquisas clínicas originais e ensaios clínicospublicados em português ou inglês. Resultados:após pesquisa e minuciosa revisão por título e resumode cada estudo, 40 ensaios clínicos randomizados foramselecionados para avaliação dos desfechos observados.Todos os estudos empregaram probióticos associadosa raspagem, alisamento e polimento coronorradicular.A cepa bacteriana mais utilizada é o Lactobacillus reuteri.Foi demonstrado que os probióticos conferem potencialauxilio ao tratamento das lesões periodontais.Embora os parâmetros avaliados nem sempre sejam beneficiadospelo tratamento, o uso dos microrganismosbenéficos reduziu a necessidade de intervenção cirúrgicaprincipalmente em pacientes com bolsas profundas.Considerações finais: A utilização dos probióticosse mostra segura e traz pequenos ganhos auxiliares notratamento das doenças que acometem o periodonto.Desenhos de estudos com rigor metodológico e amostrasrepresentativas são encorajados visando analisar etestar os benefícios desses agentes. (AU)
Objective: this study aimed to review the literature on the treatment of periodontal diseases associated with probiotics, identifying functionalities and the most used microbial agents. Material and method: a search was performed in the main electronic databases PubMed and Science Direct using the search terms "Probiotics" and "Periodontal diseases". The inclusion criteria were original clinical researches and clinical trials published in Portuguese and English. Results: after the research and meticulous revision for the title and abstract of each study, 40 randomized clinical trials were selected for evaluation of the outcomes observed. All studies used probiotics associated with scaling and crown-root planning and polishing. The most used bacterial strain was Lactobacillus reuteri. It was shown that probiotics provide potential assistance for the treatment of periodontal lesions. Although the parameters evaluated are not always favored by the treatment, the use of the beneficial microorganisms reduced the need for surgical intervention, especially in patients with deep pockets. Final considerations: the use of probiotics is safe and promotes small additional improvements in the treatment of periodontal diseases affecting the periodontium. Study designs with methodological rigor and representative samples are encouraged, aiming to analyze and test the benefits of such microbial agents. (AU)
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Humanos , Doenças Periodontais/terapia , Probióticos/uso terapêutico , Limosilactobacillus reuteri , Doenças Periodontais/microbiologia , Estomatite/terapia , Periodonto/microbiologiaRESUMO
BACKGROUND: The granulation tissue present in surgically-created early healing sockets has been considered as a possible source of osteoprogenitor cells for periodontal regeneration, as demonstrated in animal studies. However, the in vitro osteogenic properties of tissue removed from human surgically-created early healing alveolar defects (SC-EHAD) remains to be established, being that the aim of this study. METHODS: Surgical defects were created in the edentulous ridge of two systemically healthy adults. The healing tissue present in these defects was removed 21 days later for the establishment of primary culture. The in vitro characteristics of the cultured cells were determined by Armelin method, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, immunohistochemistry, alkaline phosphatase (ALP) activity, mineralization assay, and flow cytometry for detection of stem cells/osteoprogenitor cell markers. RESULTS: Cells were able to adhere to the plastic and assumed spindle-shaped morphology at earlier passages, changing to a cuboidal one with increasing passages. Differences in the proliferation rate were observed with increasing passages, suggesting osteogenic differentiation. ALP and mineralization activities were detected in conventional and osteogenic medium. Fresh samples of SC-EHAD tissue exhibited CD34- and CD45- phenotypes. Cells at later passages (14th) exhibited CD34- , CD45- , CD105- , CD166- , and collagen type I+ phenotype. CONCLUSION: Tissue removed from SC-EHAD is a possible source of progenitor cells.
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Células-Tronco Mesenquimais , Osteogênese , Adulto , Animais , Diferenciação Celular , Células Cultivadas , Humanos , Células-Tronco , CicatrizaçãoRESUMO
Pacientes com necessidades especiais (PNE) representam uma porcentagem significativa da população brasileira, correspondendo a 24% da parcela populacional. Entretanto, esses pacientes podem enfrentar diversas barreiras de acesso ao tratamento. O objetivo desse trabalho é conhecer as percepções e dificuldades encontradas por estudantes de Odontologia, referentes ao atendimento de PNE. Foi realizada a aplicação de um questionário aos graduandos do 2º ao 4º ano da Faculdade de Odontologia de Bauru (n=122), com questões referentes ao atendimento odontológico e suas percepções sobre os PNE. Observa-se que parcela significativa dos estudantes não se sentem preparados para esse atendimento, chegando a 95% no 4º ano. Sobre a percepção quanto ao preparo para atender PNE, os graduandos do 4º ano referem-se como regular, enquanto a maioria dos que cursam o 2º e 3º anos acredita não estar preparada para o atendimento. O tratamento odontológico é fundamental para o estabelecimento da saúde bucal dos pacientes, principalmente quando relacionado aos PNE, sendo essencial o conhecimento das limitações e dos recursos que levam ao acolhimento do paciente por parte dos graduandos. O contato com PNE durante a graduação é extremamente importante para o conhecimento e a ruptura de possíveis preconceitos que possam envolver o atendimento dessa população, a fim de promover saúde bucal e qualidade de vida aos PNE (AU).
Patients with special needs (PSN) represent a significant part of the Brazilian population, corresponding to 24%. However, these patients may face several barriers to access dental care. This study aimed to evaluate the perception of Dental students about PSN treatment. A questionnaire was applied to undergraduates from the 2nd to 4th year of the Faculty of Dentistry of Bauru (n = 122), with questions regarding dental care and their perceptions about PSN. It is observed that a significant number of students do not feel prepared for this service, reaching 95% in the 4th year. Regarding the perception regarding the preparation to treat PSN, the 4th year students are referred to as regular, while the majority of students in the 2nd and 3rd years believe that they are not prepared. Dental treatment is fundamental for the establishment of oral health of patients, mainly when related to PNE, being essential knowledge of limitations and resources that lead to the reception of the patient by graduates. The contact with PNE during the graduation is essentialfor the knowledge and the rupture of possible prejudices that can involve the attendance of this population, in order to promote oral health and quality of life to the PSN (AU).
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Humanos , Masculino , Feminino , Adulto , Estudantes de Odontologia , Brasil , Síndrome de Down , Pessoas com Deficiência , Assistência Odontológica para a Pessoa com Deficiência , Educação em Odontologia , Qualidade de Vida , Inquéritos e Questionários , Acesso Universal aos Serviços de SaúdeRESUMO
Root demineralization is used in Periodontics as an adjuvant for mechanical treatment. The aim of this study was to evaluate the effects of root surface modification with mechanic, chemical, and photodynamic treatments on adhesion and proliferation of human gingival fibroblasts and osteoblasts. Root fragments were treated by scaling and root planing (C-control group), EDTA (pH 7), citric acid plus tetracycline (CA-pH 1), and antimicrobial photodynamic therapy (aPDT) with toluidine blue O and red laser (pH 4). Cells were seeded (104 cells/well, 6th passage) on root fragments of each experimental group and cultured for 24, 48, and 72 h. Cells were counted in scanning electron microscopy images by a calibrated examiner. For fibroblasts, the highest number of cells were present at 72-h period (p < 0.05). EDTA group showed a very low number of cells in relation to CA group (p < 0.05). CA and aPDT group presented higher number of cells in all periods, but without differences between other treatment groups (p > 0.05). For osteoblasts, there was a significant increase in cell numbers for aPDT group at 72 h (p < 0.05). In conclusion, aPDT treatment provided a positive stimulus to osteoblast growth, while for fibroblasts, aPDT and CA had a tendency for higher cell growth.
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Anti-Infecciosos/farmacologia , Ácido Cítrico/farmacologia , Ácido Edético/farmacologia , Fibroblastos/citologia , Gengiva/citologia , Osteoblastos/citologia , Fotoquimioterapia , Raiz Dentária/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Fibroblastos/efeitos dos fármacos , Fibroblastos/ultraestrutura , Humanos , Osteoblastos/efeitos dos fármacos , Osteoblastos/ultraestrutura , Aplainamento Radicular , Tetraciclina/farmacologia , Cloreto de Tolônio/farmacologiaRESUMO
Objetivo: o objetivo desta revisão sistemática foi investigar se a condição periodontal do defeito ao redor de dentes condenados à extração, por meio de extrusão ortodôntica para reconstrução da arquitetura óssea previamente à instalação de implantes, influencia a qualidade estética final. Material e métodos: estudos relatando extrusão ortodôntica para extração de dentes e posterior instalação de implantes, acompanhados por diferentes períodos após a instalação das próteses, foram considerados elegíveis. A busca por artigos, a extração de dados e a avaliação da estética foram realizadas por examinadores independentes. A condição periodontal inicial foi classificada em tipos, a partir das radiografias iniciais presentes nos estudos: I) sem perda óssea; II) até 75%; III) até 50%; IV) até 25%; ou V) menos de 25% de inserção remanescente. A fotografia final dos casos foi analisada de acordo com o índice de estética rosa (IER). Resultados: a busca no PubMed e Scopus resultou em 453 artigos, dois quais 394 foram excluídos pelo título e 41 por não atender aos critérios de inclusão, restando 18 artigos analisados. Não houve diferença estatisticamente significante no IER observado nos diferentes tipos de defeitos periodontais iniciais (Kruskal-Wallis, p=0,17). Conclusão: esses achados sugerem que a inserção residual existente previamente à extração de dentes por meio de extrusão ortodôntica não influencia a estética final do caso, devido à reconstrução dos tecidos gengival e ósseo, favorecendo o posicionamento ideal dos implantes.
Objective: the aim of this critical analysis of literature was to investigate if the periodontal status of defects surrounding hopeless teeth submitted to extraction by orthodontic extrusion prior to implant installation interfere at the final aesthetic outcome. Material and methods: studies describing this procedure followed by different periods after prosthesis installation were considered eligible. Search, data extraction and aesthetic evaluation were made by independent examiners. Inicial periodontal status was classified in types according inicial radiographs presented on studies: I) without bone loss; II) up to 75%; III) up to 50%; IV) up to 25%; or V) less than 25% remaining insertion. Cases' final photographs were evaluated according the pink aesthetics index (PAI). Results: the search in PubMed and Scopus resulted in 453 papers of which 394 were excluded by title and 41 for not fulfill the inclusion criteria, remaining 18 papers for analysis. No statistical significance difference on PAI was observed at different inicial periodontal defects (Kruskal-Wallis, p=0.17). Conclusion: these findings suggest that the residual insertion existent prior to tooth extraction through orthodontic extrusion do not influence the aesthetic outcome because of the reconstruction of the gingival and bone tissues, favoring an optimal site for implant positioning.
Assuntos
Humanos , Osso e Ossos/anormalidades , Implantes Dentários , Estética Dentária , Extrusão Ortodôntica , Periodontite , Técnicas de Movimentação DentáriaRESUMO
A recessão gengival caracteriza-se pela migração apical da margem da gengiva, expondo a superfície radicular. Esta condição pode acarretar o desenvolvimento de hiperestesia dentinária, lesões cariosas e/ou comprometimento da estética. O tratamento por cirurgias de recobrimento radicular nem sempre é previsível, especialmente em recessões amplas e profundas, e o deslize lateral do retalho é uma das técnicas que pode ser ou não associada ao enxerto de conjuntivo subepitelial. A ativação do periósteo previamente a essa cirurgia não tem sido muito explorada nas publicações, embora exista há quase 40 anos. Este relato clínico demonstra a associação da técnica do deslize lateral do retalho à ativação do periósteo para recobrimento radicular de recessão ampla classe II de Miller, cuja queixa principal era insatisfação estética e sensibilidade dentinária. O conhecimento biológico e a correta realização da técnica, associados à eliminação do agente etiológico e rigoroso acompanhamento pós-cirúrgico, resultaram no sucesso do tratamento, como atestado pelo controle de um ano e cinco meses.
Gingival recession is characterized by the apical migration of the gingival margin that exposes the dental root surface. This condition can lead to the development of dentinal hyperesthesia, carious lesions and/or aesthetic impairment. The surgical treatment for root coverage not always provides predictable results, especially in wide and deep recessions. The horizontal sliding flap associated or not to subepithelial conjunctive grafts is a commonly employed technique, but periosteal activation prior to surgery has not been much explored in the literature, although it has existed for almost 40 years. This clinical case reports the association of horizontal sliding fl ap with the activation of the periosteum to recover a wide Miller class II recession in a patient complaining of poor aesthetic and dentin sensitivity. The biological knowledge applied to a skillful technique, associated to the elimination of the etiologic agent and rigorous post-surgical follow-up provided a succesful outcome after 1 year and 5 month observations.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Estética Dentária , Retalhos de Tecido Biológico , Retração Gengival/cirurgia , Retração Gengival/terapia , Periósteo/cirurgia , Transplante de TecidosRESUMO
Psychological stress is related to Periodontology as one of the factors involved with the pathogenesis of the periodontal disease (PD), by means of its interaction with immunological neuroendocrine system. Biological markers measuring stress levels are cortisol, α-amylase and chromogranin A (CgA). The question of this literature review was: are salivary markers sufficient to correlate psychological stress and PD?. The literature search strategy used was the combination of the uniterms: "salivary psychological stress marker" with "periodontal disease" and "psychological stress markers" with "periodontal disease" using into four database (PudMed, Scielo, LILACS, MEDLINE). Sixteen articles were recovered and 6 were included according to the analysis of salivary markers in patients whose profile varied from healthy, with gingivitis, chronic periodontitis (CP), CP located and aggressive periodontitits (AP). The article that correlated CP with AP obtained two times higher levels of CgA in patients with AP in compared to CP, and the cortisol level was higher in AP. In another study, only in patients with CP the cortisol level was related significantly to periodontal parameters such as probing depth 5-7 mm, clinical attachment level (CAL) 5-7 mm, CAL>7mm. Another showed significant correlation of CgA, α-amylase and cortisol to tooth loss. It can be concluded that there is not sufficient evidence that salivary markers are correlated with periodontal disease due the limited number of studies with reliable methodology and to the lack of agreement to confirm this information. (AU)
O estresse psicológico está relacionado com a Periodontia como um dos fatores da etiopatogenia da doença periodontal (DP) através da interação com o sistema neuroendócrino imunológico. Entre os marcadores biológicos que medem níveis de estresse encontram-se cortisol, α-amilase e cromogranina A (CgA). Esta revisão de literatura baseou-se na pergunta: marcadores salivares são suficientes para correlacionar estresse psicológico e DP?. A estratégia de busca empregou o cruzamento das palavras-chave: "marcadores salivares no estresse psicológico" com "doença periodontal" e "marcadores do estresse psicológico" com "doença periodontal" em 4 bases de dados (PubMed, Scielo, LILACS, MEDLINE). Dezesseis artigos foram recuperados e 6 foram incluídos de acordo por abordarem análise de marcadores salivares em pacientes cujo perfil variou de saudável, com gengivite, periodontite crônica (PC), PC localizada e periodontite agressiva (PA). O artigo que correlacionou PC com PA, obteve resultado de PA duas vezes maior em nível de CgA em comparação com PC. Já o nível de cortisol mostrou-se maior em PA. A medida do cortisol em outro estudo somente em pacientes com PC relacionou-se significativamente com parâmetros clínicos periodontais como, profundidade de sondagem 5-7mm, nível de inserção clínica (NIC) 5-7 mm, NIC > 7 mm. Em outro estudo que avaliou CgA, α-amilase e cortisol, houve correlação significante com perda dentária. Pode-se concluir que não há suficiente evidência de que marcadores salivares estão correlacionados com DP devido ao limitado número de estudos com metodologia confiável e falta de concordância de resultados para confirmação dessa informação (AU)
Assuntos
Doenças Periodontais , Estresse Psicológico , BiomarcadoresRESUMO
O enxerto de tecido conjuntivo subepitelial (ETCS) é considerado o padrão-ouro no recobrimento de superfícies radiculares em dentes com recessões gengivais unitárias classe I e II de Miller. Existem diferentes técnicas e áreas para coleta do ETCS, incluindo o palato lateral anterior, posterior e tuberosidade maxilar. Estas diferentes áreas fornecem enxertos com características anatômicas, formas geométricas e composições histológicas distintas. Especula-se que, devido a essas diferenças, pode haver influência no processo de revascularização do enxerto, estabilidade volumétrica e, consequentemente, no resultado clínico. Dependendo da técnica utilizada, da área e/ou profundidade na remoção do enxerto, estes podem ter diferentes formas e composições histológicas, possuindo maior ou menor parte de lâmina própria ou submucosa. Sendo assim, esta revisão da literatura buscou salientar a importância do conhecimento sobre as características dos diferentes tipos de ETCS removidos do palato, a escolha da técnica ideal de remoção e a previsibilidade dos resultados. Estudos em cadáveres, análises tomográficas e estudos clínicos relataram que a melhor área para remoção de enxerto no palato localiza-se entre o canino e a mesial do primeiro molar. A espessura da mucosa do palato aumenta da crista alveolar em direção à sutura palatina mediana, sendo que há maior predominância de lâmina própria na área próxima à margem gengival. Portanto, o planejamento da técnica de ETCS deve envolver não apenas a área receptora, mas também uma análise prévia cuidadosa da espessura e características da área doadora, o que enfatiza a importância de mais estudos clínicos randomizados avaliando diferentes características da área doadora.
The subepithelial connective tissue graft (SCTG) is considered the gold standard for root coverage procedures of Miller's class I and II gingival recessions. Different techniques and areas are considered to obtain SCTG, including anterior and posterior lateral palate and maxillary tuberosity. These areas provide different grafts considering anatomical features, geometric shapes and histological compositions. It is speculated that these differences may influence in revascularization processes, volume stability and consequently the clinical outcomes. Depending on the technique used, the area and/ or depth during removal of the graft may result in different shapes and histological compositions with majority of lamina propria or submucosa. Thus, this literature review emphasizes the importance of the knowledge about different characteristics of SCTG types removed from palate, the ideal choice of removal technique and predictability of clinical outcomes. Studies on cadavers, tomographic analysis and clinical studies have reported that the best area for graft removal in palate is located between canines and mesial of the first molars. The thickness of the palatal mucosa increases in the direction of the alveolar crest toward the palatal sutures. A predominance of lamina propria in the area near the gingival margin is observed. Therefore, the SCTG technical planning should involve not only the receptor area, but also previously a careful analysis of the thickness and characteristics of the donor area, which emphasizes the importance of more randomized clinical trials evaluating different characteristics of the donor area.
Assuntos
Humanos , Tecido Conjuntivo/transplante , Retração Gengival , Cirurgia Plástica , Transplante de Tecidos , Transplante AutólogoRESUMO
O aumento cirúrgico de coroa com finalidade estética é uma técnica bastante utilizada para restabelecer dimensões adequadas para a harmonia do sorriso, que pode ser realizada por meio da técnica cirúrgica de osteotomia com posicionamento apical do retalho. Mas, a técnica convencional pode promover a falta de proporcionalidade entre largura e altura das coroas, além de "buracos negros" interproximais, condições que levam ao fracasso na obtenção da estética. Neste relato de caso, será demonstrada uma variação no desenho do retalho para execução de osteotomia, para aumento estético da coroa clínica de incisivos superiores, no qual os efeitos indesejados supracitados são eliminados. A técnica proposta é realizada por incisões nas quais as papilas e o osso interproximal são preservados, e possibilita o acesso à tábua óssea vestibular para confecção da osteotomia. Portanto, a previsibilidade e a estabilidade dos resultados são aumentadas, assim como a satisfação do paciente. Uma paciente do sexo feminino compareceu à clínica de Periodontia da Faculdade de Odontologia de Bauru/USP queixando-se de desconforto ao sorrir, por considerar seus dentes curtos e com excesso de exposição gengival. O exame clínico atestou ausência de sinais de inflamação e ampla faixa de gengiva ceratinizada. O procedimento de aumento cirúrgico das coroas clínicas com preservação da papila inter- dental foi proposto. O controle de 14 meses de acompanhamento comprovou que a aplicação da técnica conservadora sugerida apresentou um resultado estético estável e uma recuperação previsível, demonstrando ser uma ferramenta vantajosa no tratamento cirúrgico de coroas clínicas curtas.
Crown lengthening with aesthetic purposes is a widely used technique for restoring dimensions suitable for smile harmony, which can be accomplished by surgical osteotomy with flap apical positioning. But the conventional technique can promote the lack of proportionality between crown width and height, as well as interproximal "black spaces", conditions that lead to compromised esthetics. For these factors, in this case report we demonstrate a variation in the flap design for osteotomy with esthetic clinical crown lengthening of the upper incisors, in which the undesired effects are eliminated. The proposed technique uses incisions that preserve the papillae and interproximal bone and provides access to the buccal bone plate for osteotomy. Therefore, predictability and stability of the results is increased, as well as patient satisfaction. A female patient attended the Periodontology clinic, Bauru School of Dentistry/USP complaining of discomfort while smiling due to her short clinical crowns and excessive dental displaying. The clinical examination attested absence of signs of inflammation and wide range of keratinized gingiva and the crown lengthening procedure with preservation of interdental papilla was proposed and expressly accepted by patient. Fortheen months later, it was demonstrated that the application of the suggested conservative technique showed stable aesthetic results and a predictable recovery, proving to be an advantageous tool for the surgical treatment of short clinical crowns.