RESUMO
AIMS: To explore the influence of gender on periodontal treatment outcomes in a dataset of eight RCTs conducted in Brazil, United States, and Germany. METHODS: Clinical parameters were compared between men and women with stages III/IV grades B/C generalized periodontitis at baseline and 1-year post-therapy, including scaling and root planing with or without antibiotics. RESULTS: Data from 1042 patients were analyzed. Men presented a tendency towards higher probing depth (p = .07, effect size = 0.11) and clinical attachment level (CAL) than women at baseline (p = .01, effect size = 0.16). Males also presented statistically significantly lower CAL gain at sites with CAL of 4-6 mm at 1-year post-therapy (p = .001, effect size = 0.20). Among patients with Grade B periodontitis who took antibiotics, a higher frequency of women achieved the endpoint for treatment (i.e., ≤4 sites PD ≥5 mm) at 1 year than men (p < .05, effect size = 0.12). CONCLUSION: Men enrolled in RCTs showed a slightly inferior clinical response to periodontal therapy in a limited number of sub-analyses when compared to women. These small differences did not appear to be clinically relevant. Although gender did not dictate the clinical response to periodontal treatment in this population, our findings suggest that future research should continue to explore this topic.
RESUMO
This review aimed to assess the impact of dietary omega-3 fatty acids as an adjunct to non-surgical periodontal treatment when compared with periodontal treatment alone on periodontal clinical parameters of periodontitis patients. We included only randomized clinical trials (RCTs) with at least 3-months follow-up of non-surgical periodontal therapy, in combination with dietary omega-3 fatty acids. The MEDLINE, EMBASE, and LILACS databases were searched for articles published up to October 2021. Random-effects meta-analyses were conducted to determine the change in clinical attachment level (CAL), probing pocket depth (PPD), bleeding on probing (BOP), and gingival index (GI) after therapy. Of the eight hundred eighty-four potentially relevant papers retrieved from the electronic databases, 10 RCTs were selected for qualitative analysis, and of these, 8 RCTs were included in meta-analysis. RCTs showed a significant PPD reduction/CAL gain associated with the use of omega-3 fatty acids. The pooled estimates revealed significant overall PPD reduction of 0.42 mm (95% CI 0.15, 0.68) and CAL gain 0.58 mm (95% CI 0.24, 0.92). In individuals with periodontitis, the use of omega-3 fatty acid dietary supplementation as an adjunct to non-surgical periodontal treatment can provide additional benefits in CAL gain and PPD reduction, compared with non-surgical periodontal treatment alone.
Assuntos
Periodontite Crônica , Ácidos Graxos Ômega-3 , Periodontite , Periodontite Crônica/tratamento farmacológico , Raspagem Dentária , Ácidos Graxos Ômega-3/uso terapêutico , Humanos , Índice Periodontal , Periodontite/tratamento farmacológico , Aplainamento RadicularRESUMO
Natural or synthetic ligands for peroxisome proliferator-activated receptor gamma (PPAR-γ) represent an interesting tool for pharmacological interventions to treat inflammatory conditions. In particular, PPAR-γ activation prevents pain and inflammation in the temporomandibular joint (TMJ) by decreasing cytokine release and stimulating the synthesis of endogenous opioids. The goal of this study was to clarify whether PPAR-γ activation induces macrophage polarization, inhibiting inflammatory cytokine release and leukocyte recruitment. In addition, we investigated the involvement of heme oxygenase 1 (HO-1) in downstream events after PPAR-γ activation. Our results demonstrate that PPAR-γ activation ablates cytokine release by Bone Marrow-Derived Macrophages (BMDM) in vitro. 15d-PGJ2 induces the PPAR-γ heterodimer activation from rat macrophages, with macrophage polarization from M1-like cells toward M2-like cells. This response is mediated through HO-1. PPAR-γ activation diminished neutrophil migration induced by carrageenan, which was also HO-1 dependent. Ca2+/calmodulin expression did not change after PPAR-γ activation indicating that is not required for the activation of the intracellular L-arginine/NO/cGMP/K+ATP channel pathway. In summary, the anti-inflammatory actions induced by PPAR-γ activation involve macrophage polarization. HO-1 expression is increased and HO-1 activity is required for the suppression of neutrophil migration.
Assuntos
Heme Oxigenase-1/imunologia , Macrófagos/imunologia , Neutrófilos/fisiologia , PPAR gama/imunologia , Anilidas/farmacologia , Animais , Proteína Quinase Tipo 2 Dependente de Cálcio-Calmodulina/imunologia , Carragenina/farmacologia , Movimento Celular/efeitos dos fármacos , Células Cultivadas , Citocinas/imunologia , Humanos , Lipopolissacarídeos/farmacologia , Macrófagos/efeitos dos fármacos , Masculino , Camundongos Endogâmicos C57BL , Neutrófilos/efeitos dos fármacos , Óxido Nítrico/imunologia , Prostaglandina D2/análogos & derivados , Prostaglandina D2/farmacologia , Ratos Wistar , Articulação Temporomandibular/efeitos dos fármacos , Articulação Temporomandibular/imunologiaRESUMO
OBJECTIVE: The selection of proper outcome measures is a critical step in clinical research. Most randomized clinical trials (RCTs) assessing the effects of initial anti-infective periodontal therapies use surrogate outcomes as primary outcome variables, such as mean changes in probing depth (PD) or in clinical attachment. However, these parameters do not reflect disease remission/control at patient level, which has led to subjective interpretations of the data from RCTs and Systematic Reviews. Based on a comprehensive analysis of 724 patients from USA, Germany and Brazil treated for periodontitis, this paper suggests that the clinical endpoint of "≤4 sites with PD≥5mm" is effective in determining disease remission/control after active periodontal treatment and therefore, may represent a pertinent endpoint for applying the treat-to-target concept in RCTs. Furthermore, regression models showed that the presence of >10% and >20% sites with bleeding on probing in the mouth post-treatment increases the risk of a patient leaving the endpoint from 1-2 years (OR=3.5 and 8.7, respectively). Researchers are encouraged to present results on this outcome when reporting their trials, as this will allow for an objective comparison across studies and facilitate systematic reviews, and consequently, the extrapolation of data from research to clinical practice.
Assuntos
Periodontite , Brasil , Alemanha , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como AssuntoRESUMO
BACKGROUND: Supplementation with omega-3 polyunsaturated fatty acids (ω-3 PUFA) and low-dose aspirin (ASA) have been proposed as a host modulation regimen to control chronic inflammatory diseases. The aim of this study was to investigate the clinical and immunological impact of orally administered ω-3 PUFA and ASA as adjuncts to periodontal debridement for the treatment of periodontitis in patients type 2 diabetes. METHODS: Seventy-five patients (n = 25/group) were randomly assigned to receive placebo and periodontal debridement (CG), ω-3 PUFA + ASA (3 g of fish oil/d + 100 mg ASA/d for 2 months) after periodontal debridement (test group [TG]1), or ω-3 PUFA + ASA (3 g of fish oil/d + 100 mg ASA/d for 2 months) before periodontal debridement (TG2). Periodontal parameters and GCF were collected at baseline (t0), 3 months after periodontal debridement and ω-3 PUFA + ASA or placebo for TG1 and CG (t1), after ω-3 PUFA + ASA (before periodontal debridement) for TG2 (t1), and 6 months after periodontal debridement (all groups) (t2). GCF was analyzed for cytokine levels by multiplex ELISA. RESULTS: Ten patients (40%) in TG1 and nine patients (36%) in TG2 achieved the clinical endpoint for treatment (less than or equal to four sites with probing depth ≥ 5 mm), as opposed to four (16%) in CG. There was clinical attachment gain in moderate and deep pockets for TG1. IFN-γ and interleukin (IL)-8 levels decreased over time for both test groups. IL-6 levels were lower for TG1. HbA1c levels reduced for TG1. CONCLUSION: Adjunctive ω-3 and ASA after periodontal debridement provides clinical and immunological benefits to the treatment of periodontitis in patients with type 2 diabetes.
Assuntos
Periodontite Crônica , Diabetes Mellitus Tipo 2 , Aspirina/uso terapêutico , Periodontite Crônica/tratamento farmacológico , Periodontite Crônica/cirurgia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Método Duplo-Cego , Humanos , Perda da Inserção Periodontal , Desbridamento Periodontal , Bolsa Periodontal/tratamento farmacológico , Bolsa Periodontal/cirurgiaRESUMO
INTRODUCTION: Pulp necrosis in immature teeth and the resulting periodontal apical inflammation negatively affect root formation. Resolvin E1 (RvE1) is a lipid-derived endogenous pro-resolution molecule that controls inflammation. The aim of this investigation was to evaluate the impact of RvE1 applied as an intracanal medication on root formation in nonvital immature teeth. METHODS: To arrest root development, pulpectomy was performed in the lower first molars of 4-week-old Wistar rats. After 3 weeks, irrigation with 2.5% sodium hypochlorite and 0.9% sterile saline was performed, and either a triple antibiotic paste (TAP) or RvE1 in saline was applied into the root canals. In the control group, access openings drilled into molars were left exposed to the oral environment. Root development and periapical repair were evaluated radiographically and histologically at 3 and 6 weeks after treatment. RESULTS: RvE1 reduced periapical lesion size compared with the control at 3 weeks, which was similar to TAP. Inflammatory response in the RvE1-treated group was markedly reduced compared with both TAP and control specimens. At 6 weeks, root development was observed in both groups, but RvE1 treatment produced less cellularity with more regular calcified tissue deposition. CONCLUSIONS: RvE1 and TAP had a positive impact on reducing inflammation and promoting root formation. RvE1 was more effective in reducing inflammation at earlier stages. RvE1 has potential to be used as root canal dressing to control inflammation in endodontically compromised teeth before complete root formation. Stability of RvE1 within the root canal and its delivery are issues to be addressed before its clinical use.
Assuntos
Anti-Inflamatórios/uso terapêutico , Cavidade Pulpar/efeitos dos fármacos , Necrose da Polpa Dentária/tratamento farmacológico , Ácido Eicosapentaenoico/análogos & derivados , Irrigantes do Canal Radicular/uso terapêutico , Raiz Dentária/efeitos dos fármacos , Dente não Vital/tratamento farmacológico , Animais , Antibacterianos/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Ciprofloxacina/uso terapêutico , Ácido Eicosapentaenoico/administração & dosagem , Ácido Eicosapentaenoico/uso terapêutico , Masculino , Metronidazol/uso terapêutico , Minociclina/uso terapêutico , Odontogênese/efeitos dos fármacos , Periodontite Periapical/terapia , Pulpectomia/métodos , Ratos , Ratos Wistar , Hipoclorito de Sódio/uso terapêutico , Calcificação de Dente/efeitos dos fármacos , Raiz Dentária/crescimento & desenvolvimentoRESUMO
BACKGROUND: During inflammatory periodontal disease, peripheral blood mononuclear cells (PBMCs) are attracted to bone and differentiate into active bone-resorbing osteoclasts (OCs), thus providing evidence that the impact of chronic periodontitis (CP) on the activity of circulating mononuclear cells is of central importance. The authors test the hypothesis that peripheral blood mononuclear phagocytes (PBMPs) from patients with CP are activated and more susceptible to differentiation into OCs, which in turn would lead to more intense bone resorption. METHODS: In vitro cytokine production by both unstimulated and lipopolysaccharide-stimulated PBMCs from individuals with (n = 10) or without (n = 12) periodontitis was determined by cytokine array. OC differentiation from CD14(+) PBMCs was induced by receptor activator of nuclear factor-kappa B ligand (RANKL), either alone or in the presence of macrophage colony-stimulating factor (M-CSF). PBMC differentiation to OCs was confirmed by tartrate-resistant acid phosphatase staining; bone resorbing activity was assessed by using an osteologic plate assay (bone resorption pit formation). RESULTS: PBMCs from patients with CP produced tumor necrosis factor-α and higher amounts of interferon-γ, interleukin (IL)-1α, IL-1ß, IL-1rα, CXC motif chemokine 10, macrophage migration inhibitory factor, macrophage inflammatory protein (MIP)-1α, and MIP-1ß than the control cells. OC differentiation was induced by RANKL alone in PBMCs from patients with CP, but not in PBMCs from the healthy controls, which required the addition of M-CSF. In addition, PBMC-derived OCs from patients with CP showed significantly higher resorption activity than that observed in the healthy controls. Also, the circulating concentrations of M-CSF were significantly higher in patients with CP than in the control participants. CONCLUSIONS: These data indicate that in patients with CP, circulating PBMCs are primed for increased proinflammatory activity and that M-CSF plays a central role in this process by increasing OC formation and the consequent bone resorption activity.
Assuntos
Periodontite Crônica/sangue , Osteoclastos/fisiologia , Fagócitos/fisiologia , Fosfatase Ácida/análise , Adulto , Reabsorção Óssea/patologia , Técnicas de Cultura de Células , Diferenciação Celular/efeitos dos fármacos , Diferenciação Celular/fisiologia , Quimiocina CCL3/análise , Quimiocina CCL4/análise , Quimiocina CXCL10/análise , Periodontite Crônica/patologia , Humanos , Interferon gama/análise , Proteína Antagonista do Receptor de Interleucina 1/análise , Interleucina-1alfa/análise , Interleucina-1beta/análise , Isoenzimas/análise , Receptores de Lipopolissacarídeos/análise , Lipopolissacarídeos/farmacologia , Fator Estimulador de Colônias de Macrófagos/sangue , Fator Estimulador de Colônias de Macrófagos/farmacologia , Fatores Inibidores da Migração de Macrófagos/análise , Masculino , Óxido Nítrico/análise , Osteoclastos/efeitos dos fármacos , Fagócitos/classificação , Fagócitos/efeitos dos fármacos , Ligante RANK/farmacologia , Fosfatase Ácida Resistente a Tartarato , Fator de Necrose Tumoral alfa/análiseRESUMO
OBJECTIVES: The aim of this study was to compare the pattern of secretion and the expression of mucin glycoprotein-2 (MG2) and lactoferrin in individuals with or without periodontitis. MATERIAL AND METHODS: Five individuals with aggressive periodontitis (APG), 5 with generalized chronic periodontitis (CPG) and 5 without periodontitis (CG) were enrolled after informed consent. Non-stimulated and stimulated submandibular and sublingual saliva was collected and samples analyzed by Western blot probed with specific antibodies. RESULTS: Stimulated and non-stimulated salivary flow rates did not differ among groups. Western blot analysis revealed that stimulation led to: an increase in MG2 expression in all groups, and to lactoferrin expression in APG and CPG. In non-stimulated saliva, CG exhibited the highest expression of both glycoproteins. In stimulated saliva, CG exhibited the highest expression of MG2, whereas APG the highest of lactoferrin. CONCLUSIONS: The pattern of secretion of MG2 and lactoferrin in health and disease is complex. Although the present study analyzed samples from a limited number of participants, the reduced expression of MG2 and lactoferrin in APG and CPG under non-stimulated condition, the predominant circumstance of salivary secretion during the day, suggests that these salivary constituents may play a role in the etiopathogenesis of these diseases.
Assuntos
Periodontite Agressiva/metabolismo , Periodontite Crônica/metabolismo , Lactoferrina/análise , Mucina-2/análise , Saliva/química , Glândulas Salivares/metabolismo , Adulto , Western Blotting , Estudos de Casos e Controles , Eletroforese em Gel de Poliacrilamida , Feminino , Humanos , Lactoferrina/metabolismo , Masculino , Pessoa de Meia-Idade , Mucina-2/metabolismo , Taxa Secretória , Fatores de TempoRESUMO
OBJECTIVES:The aim of this study was to compare the pattern of secretion and the expression of mucin glycoprotein-2 (MG2) and lactoferrin in individuals with or without periodontitis. MATERIAL AND METHODS: Five individuals with aggressive periodontitis (APG), 5 with generalized chronic periodontitis (CPG) and 5 without periodontitis (CG) were enrolled after informed consent. Non-stimulated and stimulated submandibular and sublingual saliva was collected and samples analyzed by Western blot probed with specific antibodies. RESULTS: Stimulated and non-stimulated salivary flow rates did not differ among groups. Western blot analysis revealed that stimulation led to: an increase in MG2 expression in all groups, and to lactoferrin expression in APG and CPG. In non-stimulated saliva, CG exhibited the highest expression of both glycoproteins. In stimulated saliva, CG exhibited the highest expression of MG2, whereas APG the highest of lactoferrin. CONCLUSIONS: The pattern of secretion of MG2 and lactoferrin in health and disease is complex. Although the present study analyzed samples from a limited number of participants, the reduced expression of MG2 and lactoferrin in APG and CPG under non-stimulated condition, the predominant circumstance of salivary secretion during the day, suggests that these salivary constituents may play a role in the etiopathogenesis of these diseases.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Periodontite Agressiva/metabolismo , Periodontite Crônica/metabolismo , Lactoferrina/análise , /análise , Saliva/química , Glândulas Salivares , Western Blotting , Estudos de Casos e Controles , Eletroforese em Gel de Poliacrilamida , Lactoferrina/metabolismo , /metabolismo , Taxa Secretória , Fatores de TempoRESUMO
BACKGROUND: This study compares the changes to the subgingival microbiota of individuals with "refractory" periodontitis (RP) or treatable periodontitis (good responders [GR]) before and after periodontal therapy by using the Human Oral Microbe Identification Microarray (HOMIM) analysis. METHODS: Individuals with chronic periodontitis were classified as RP (n = 17) based on mean attachment loss (AL) and/or >3 sites with AL ≥2.5 mm after scaling and root planing, surgery, and systemically administered amoxicillin and metronidazole or as GR (n = 30) based on mean attachment gain and no sites with AL ≥2.5 mm after treatment. Subgingival plaque samples were taken at baseline and 15 months after treatment and analyzed for the presence of 300 species by HOMIM analysis. Significant differences in taxa before and post-therapy were sought using the Wilcoxon test. RESULTS: The majority of species evaluated decreased in prevalence in both groups after treatment; however, only a small subset of organisms was significantly affected. Species that increased or persisted in high frequency in RP but were significantly reduced in GR included Bacteroidetes sp., Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotella spp., Tannerella forsythia, Dialister spp., Selenomonas spp., Catonella morbi, Eubacterium spp., Filifactor alocis, Parvimonas micra, Peptostreptococcus sp. OT113, Fusobacterium sp. OT203, Pseudoramibacter alactolyticus, Streptococcus intermedius or Streptococcus constellatus, and Shuttlesworthia satelles. In contrast, Capnocytophaga sputigena, Cardiobacterium hominis, Gemella haemolysans, Haemophilus parainfluenzae, Kingella oralis, Lautropia mirabilis, Neisseria elongata, Rothia dentocariosa, Streptococcus australis, and Veillonella spp. were more associated with therapeutic success. CONCLUSION: Persistence of putative and novel periodontal pathogens, as well as low prevalence of beneficial species was associated with chronic refractory periodontitis.
Assuntos
Bactérias/classificação , Periodontite Crônica/microbiologia , Periodontite Crônica/terapia , Placa Dentária/microbiologia , Tipagem Molecular/métodos , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Amoxicilina/uso terapêutico , Anti-Infecciosos/uso terapêutico , Distribuição de Qui-Quadrado , Periodontite Crônica/patologia , DNA Bacteriano/genética , Raspagem Dentária , Combinação de Medicamentos , Feminino , Humanos , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Bucais , RNA Ribossômico 16S/genética , Estatísticas não ParamétricasRESUMO
BACKGROUND: Inflammatory stimuli activate inducible nitric oxide synthase (iNOS) in a variety of cell types, including osteoclasts (OC) and osteoblasts, resulting in sustained NO production. In this study, we evaluate the alveolar bone loss in rats with periodontitis under long-term iNOS inhibition, and the differentiation and activity of OC from iNOS-knockout (KO) mice in vitro. METHODS: Oral aminoguanidine (an iNOS inhibitor) or water treatment was started 2 weeks before induction of periodontitis. Rats were sacrificed 3, 7, or 14 days after ligature placement, and alveolar bone loss was evaluated. In vitro OC culture experiments were also performed to study the differentiation of freshly isolated bone marrow cells from both iNOS KO and wild-type C57BL/6 mice. OC were counted 6 days later after tartrate-resistant acid phosphatase staining (a marker of osteoclast identity), and bone resorption activity was assessed by counting the number of resorption pits on dentin disks. RESULTS: Rats with ligature showed progressive and significant alveolar bone loss compared to sham animals, and aminoguanidine treatment significantly inhibited ligature-induced bone loss at 7 and 14 days after the induction. In comparison to bone marrow cells from wild-type mice, cells from iNOS KO mice showed decreased OC growth and the resulting OC covered a smaller culture dish area and generated fewer resorption pit counts. CONCLUSION: Our results demonstrate that iNOS inhibition prevents alveolar bone loss in a rat model of ligature-induced periodontitis, thus confirming that iNOS-derived NO plays a crucial role in the pathogenesis of periodontitis, probably by stimulating OC differentiation and activity.
Assuntos
Perda do Osso Alveolar/enzimologia , Óxido Nítrico Sintase Tipo II/metabolismo , Óxido Nítrico/metabolismo , Osteoclastos/metabolismo , Periodontite/complicações , Perda do Osso Alveolar/complicações , Animais , Reabsorção Óssea/complicações , Reabsorção Óssea/enzimologia , Células Cultivadas , Inibidores Enzimáticos/farmacologia , Guanidinas/farmacologia , Técnicas In Vitro , Masculino , Óxido Nítrico Sintase Tipo II/efeitos dos fármacos , Osteoclastos/citologia , Periodontite/metabolismo , Ratos , Ratos WistarRESUMO
OBJECTIVE: in this study we have assessed the renal and cardiac consequences of ligature-induced periodontitis in both normotensive and nitric oxide (NO)-deficient (L-NAME-treated) hypertensive rats. MATERIALS AND METHODS: oral L-NAME (or water) treatment was started two weeks prior to induction of periodontitis. Rats were sacrificed 3, 7 or 14 days after ligature placement, and alveolar bone loss was evaluated radiographically. Thiobarbituric reactive species (TBARS; a lipid peroxidation index), protein nitrotyrosine (NT; a marker of protein nitration) and myeloperoxidase activity (MPO; a neutrophil marker) were determined in the heart and kidney. RESULTS: in NO-deficient hypertensive rats, periodontitis-induced alveolar bone loss was significantly diminished. In addition, periodontitis-induced cardiac NT elevation was completely prevented by L-NAME treatment. On the other hand L-NAME treatment enhanced MPO production in both heart and kidneys of rats with periodontitis. No changes due to periodontitis were observed in cardiac or renal TBARS content. CONCLUSIONS: in addition to mediating alveolar bone loss, NO contributes to systemic effects of periodontitis in the heart and kidney.
Assuntos
Sequestradores de Radicais Livres/antagonistas & inibidores , Hipertensão/metabolismo , Rim/metabolismo , Miocárdio/metabolismo , Óxido Nítrico/antagonistas & inibidores , Periodontite/metabolismo , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/metabolismo , Animais , Modelos Animais de Doenças , Inibidores Enzimáticos/farmacologia , Coração/efeitos dos fármacos , Rim/efeitos dos fármacos , Masculino , NG-Nitroarginina Metil Éster/farmacologia , Óxido Nítrico Sintase/antagonistas & inibidores , Estresse Oxidativo/fisiologia , Periodontite/diagnóstico por imagem , Peroxidase/análise , Radiografia , Ratos , Ratos Wistar , Substâncias Reativas com Ácido Tiobarbitúrico/análise , Tirosina/análogos & derivados , Tirosina/análiseRESUMO
BACKGROUND: The treatment of molar furcation defects remains a considerable challenge in clinical practice. The degree of success in the management of furcation involvement is highly variable and inversely related to initial probing depth (PD) measurements in these lesions. The identification of clinical measurements influential to the treatment outcomes is critical to optimize the results of surgical periodontal therapy. Therefore, the objective of this study was to evaluate the clinical response of mandibular buccal Class II furcation lesions to a combined regenerative treatment modality. METHODS: Sixty patients were divided into two (n = 30) treatment groups. An experimental combined regenerative therapy (ET) was compared to open flap debridement (OFD). The ET was a combination of a composite graft consisting of bioabsorbable hydroxyapatite and tetracycline (3:1), a guided tissue regeneration barrier, and a coronally advanced flap. The clinical variables evaluated were plaque, bleeding on probing, gingival recession, PD, vertical attachment level (VAL), horizontal attachment level (HAL), furcation vertical height, furcation horizontal depth, and the amount of tissue under the barrier membrane at uncovering. Reevaluation was performed 12 months after the surgical procedure. RESULTS: Both treatments resulted in improvements in all clinical variables evaluated. Postoperative measurements revealed a reduction in PD of 3.65 +/- 0.6 mm and 0.60 +/- 1.0 mm; VAL gains of 3.05 +/- 0.6 mm and 0.65 +/- 0.6 mm and HAL gains of 3.45 +/- 1.3 mm and 0.55 +/- 0.7 mm in the ET and OFD groups, respectively. In the ET group, significant positive correlations were found between baseline PD and PD reduction at 12 months, and the initial VAL correlated positively with PD reduction and HAL gain. The horizontal furcation depth and amount of tissue formed under the membrane at uncovering correlated positively with PD reduction and HAL and VAL gains. For the OFD group, the initial PD correlated positively with PD reduction and VAL and HAL gains and correlated negatively with recession. Initial VAL correlated positively with PD reductions and VAL and HAL gains. The initial HAL correlated negatively with recession at 12 months. CONCLUSIONS: ET exhibited significantly better clinical results, with more PD reduction, HAL and VAL gains, and a higher frequency of furcation closure compared to OFD and showed promise as a regenerative treatment technique. The ability to predict a response to treatment based upon pretreatment parameters was not consistent between groups; thus, prediction of treatment outcomes based on pretreatment measurements should be carefully evaluated for each treatment modality.
Assuntos
Defeitos da Furca/cirurgia , Regeneração Tecidual Guiada Periodontal/métodos , Doenças Mandibulares/cirurgia , Implantes Absorvíveis , Adulto , Alveoloplastia , Antibacterianos/uso terapêutico , Regeneração Óssea/fisiologia , Substitutos Ósseos/uso terapêutico , Desbridamento , Índice de Placa Dentária , Durapatita/uso terapêutico , Feminino , Seguimentos , Hemorragia Gengival/cirurgia , Retração Gengival/cirurgia , Humanos , Masculino , Membranas Artificiais , Pessoa de Meia-Idade , Perda da Inserção Periodontal/cirurgia , Índice Periodontal , Bolsa Periodontal/cirurgia , Estudos Prospectivos , Retalhos Cirúrgicos , Tetraciclina/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND: This study compared the subgingival microbiota of subjects with refractory periodontitis (RP) to those in subjects with treatable periodontitis (GRs = good responders) or periodontal health (PH) using the Human Oral Microbe Identification Microarray (HOMIM). METHODS: At baseline, subgingival plaque samples were taken from 47 subjects with periodontitis and 20 individuals with PH and analyzed for the presence of 300 species by HOMIM. The subjects with periodontitis were classified as having RP (n = 17) based on mean attachment loss (AL) and/or more than three sites with AL >or=2.5 mm after scaling and root planing, surgery, and systemically administered amoxicillin and metronidazole or as GRs (n = 30) based on mean attachment gain and no sites with AL >or=2.5 mm after treatment. Significant differences in taxa among the groups were sought using the Kruskal-Wallis and chi(2) tests. RESULTS: More species were detected in patients with disease (GR or RP) than in those without disease (PH). Subjects with RP were distinguished from GRs or those with PH by a significantly higher frequency of putative periodontal pathogens, such as Parvimonas micra (previously Peptostreptococcus micros or Micromonas micros), Campylobacter gracilis, Eubacterium nodatum, Selenomonas noxia, Tannerella forsythia (previously T. forsythensis), Porphyromonas gingivalis, Prevotella spp., Treponema spp., and Eikenella corrodens, as well as unusual species (Pseudoramibacter alactolyticus, TM7 spp. oral taxon [OT] 346/356, Bacteroidetes sp. OT 272/274, Solobacterium moorei, Desulfobulbus sp. OT 041, Brevundimonas diminuta, Sphaerocytophaga sp. OT 337, Shuttleworthia satelles, Filifactor alocis, Dialister invisus/pneumosintes, Granulicatella adiacens, Mogibacterium timidum, Veillonella atypica, Mycoplasma salivarium, Synergistes sp. cluster II, and Acidaminococcaceae [G-1] sp. OT 132/150/155/148/135) (P <0.05). Species that were more prevalent in subjects with PH than in patients with periodontitis included Actinomyces sp. OT 170, Actinomyces spp. cluster I, Capnocytophaga sputigena, Cardiobacterium hominis, Haemophilus parainfluenzae, Lautropia mirabilis, Propionibacterium propionicum, Rothia dentocariosa/mucilaginosa, and Streptococcus sanguinis (P <0.05). CONCLUSION: As determined by HOMIM, patients with RP presented a distinct microbial profile compared to patients in the GR and PH groups.
Assuntos
Bactérias/classificação , Periodontite Crônica/microbiologia , Periodontite/microbiologia , Periodonto/microbiologia , Adulto , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Bacteroides/classificação , Bacteroidetes/classificação , Campylobacter/classificação , Periodontite Crônica/terapia , Placa Dentária/microbiologia , Raspagem Dentária , Eikenella corrodens/classificação , Eubacterium/classificação , Feminino , Bactérias Gram-Negativas/classificação , Bactérias Gram-Positivas/classificação , Humanos , Masculino , Metronidazol/uso terapêutico , Análise em Microsséries , Pessoa de Meia-Idade , Peptostreptococcus/classificação , Periodontite/terapia , Porphyromonas gingivalis/classificação , Prevotella/classificação , Proteobactérias/classificação , Aplainamento Radicular , Selenomonas/classificação , Treponema/classificaçãoRESUMO
It has been demonstrated that kinin B(1) receptors are highly up-regulated under several stressful stimuli, such as infection. However, there is no evidence indicating whether Porphyromonas gingivalis lipopolysaccharide (Pg-LPS) might lead to B(1) receptor up-regulation. In this study, we demonstrate that Pg-LPS injection into the rat paw resulted in a marked functional up-regulation of B(1) receptors (as measured by an increase of B(1) receptor-induced edema), which was preceded by a rapid rise in B(1) receptor mRNA expression. The local administration of Pg-LPS also resulted in a prominent production of the proinflammatory cytokine tumor necrosis factor alpha (TNF-alpha), followed by an increase of neutrophil influx; both events were observed at periods before B(1) receptor induction. The functional and molecular Pg-LPS-elicited B(1) receptor up-regulation was significantly reduced by the glucocorticoid dexamethasone (0.5 mg/kg s.c.), and to a lesser extent by the chimeric anti-TNF-alpha antibody infliximab (1 mg/kg s.c.). Of high relevance, we show for the first time that a single administration of the proresolution lipid mediator (5S,12R,18R)-trihydroxy-6Z,8E,10E,14Z,16E-eicosapentaenoic acid (resolvin E1; 300 ng/rat i.p.) was able to markedly down-regulate Pg-LPS-driven B(1) receptor expression, probably by inhibiting TNF-alpha production and neutrophil migration. Collectively, the present findings clearly suggest that Pg-LPS is able to induce the up-regulation of B(1) receptors through mechanisms involving TNF-alpha release and neutrophil influx, which are largely sensitive to resolvin E1. It is tempting to suggest that kinin B(1) receptors might well represent a pivotal pathway for the inflammatory responses evoked by P. gingivalis and its virulence factors.
Assuntos
Lipopolissacarídeos/farmacologia , Porphyromonas gingivalis/química , Receptor B1 da Bradicinina/biossíntese , Animais , Anti-Inflamatórios/farmacologia , Anticorpos Monoclonais/farmacologia , Bradicinina/análogos & derivados , Bradicinina/farmacologia , Dexametasona/farmacologia , Edema/induzido quimicamente , Edema/metabolismo , Edema/patologia , Ácido Eicosapentaenoico/análogos & derivados , Ácido Eicosapentaenoico/farmacologia , Pé/patologia , Infliximab , Masculino , Infiltração de Neutrófilos/efeitos dos fármacos , Neutrófilos/efeitos dos fármacos , Neutrófilos/enzimologia , Peroxidase/metabolismo , RNA Mensageiro/biossíntese , RNA Mensageiro/genética , Ratos , Ratos Wistar , Receptor B1 da Bradicinina/efeitos dos fármacos , Regulação para Cima/efeitos dos fármacosRESUMO
OBJECTIVE: To evaluate the influence of examiner experience on the variability of periodontal probing depth measurements obtained by conventional manual probing. METHOD AND MATERIALS: Thirty subjects with a diagnosis of chronic periodontitis were evaluated by an experienced examiner using an electronic probe and randomly assigned to 3 groups. Examiners with different levels of experience (undergraduate students, postgraduate students, and associate professors) evaluated each group with a manual probe. Electronic and conventional probing were repeated 45 days after cause-related periodontal therapy. RESULTS: A total of 8,127 periodontal sites were evaluated at the baseline examination and reassessment. Agreement between methods was satisfactory at the baseline examination (kappa = 0.45; P < .001) and reassessment (kappa = 0.42; P < .001). The best agreement between electronic and manual probing at the baseline examination was obtained by the postgraduate students (kappa = 0.66) and at reassessment by the associate professors (kappa = 0.60). Undergraduate students obtained the lowest agreement values in both examinations (kappa = 0.42 and 0.11, respectively). CONCLUSION: Examiner experience has direct influence on the accuracy of measurements. Dental schools must evaluate if the methodology employed to teach the use of conventional manual probing is effectively qualifying their students for dental practice.