RESUMO
BACKGROUND: The aim of the present study was to compare repeated applications of antimicrobial photodynamic therapy (aPDT) to open flap debridement (OFD) in the treatment of residual periodontal pockets in non-furcation sites. METHODS: Forty-six subjects with a diagnosis of Stage III or IV Grade C periodontitis, that had been previously treated, participated in the study. Residual pockets were divided between two groups: (1) aPDT group: received ultrasonic periodontal debridement followed by immediate application of aPDT, and repeated on1st, 2nd, 7th, and 14th days; and (2) OFD group: treated by modified papilla preservation technique, where granulation tissue and visible calculus were removed with hand curettes and an ultrasonic device. Clinical, immunological, and microbiological parameters were evaluated before and after treatment. RESULTS: Both treatments were effective reducing clinical parameters of disease. OFD resulted in a greater mean probing pocket depths (PPD) reduction in deep pockets (p = 0.001). However, aPDT resulted in a lower occurrence of gingival recession (GR), dentin hypersensitivity (DH) and analgesic intake. Reduction in Porphyromonas gingivalis was observed in both groups. Only the OFD group had a significant reduction in Aggregatibacter actinomycetemcomitans. aPDT group had greater increase in interleukin 10 (IL-10) levels and a greater reduction of interleukin 1 beta (IL-1ß) at 14 days when compared to the OFD group (p < 0.05). CONCLUSION: OFD was superior in reducing PPD in deep pockets compared to the aPDT. However, OFD resulted in greater GR. Both treatments lowered P. gingivalis levels but only OFD reduced levels of A. actinomycemtemcomitans.
Assuntos
Retração Gengival , Fotoquimioterapia , Humanos , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Desbridamento , Terapia Combinada , Desbridamento Periodontal/métodos , Retração Gengival/tratamento farmacológico , Retração Gengival/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: This split-mouth randomized controlled trial aimed to evaluate the effect of enamel matrix derivative (EMD) associated with a simplified papilla preservation flap (SPPF) compared to SPPF alone in the surgical treatment of intrabony defects (ID) in type 2 diabetic mellitus (T2DM) patients. MATERIAL AND METHODS: Thirteen patients with controlled T2DM presenting with ID in at least two quadrants were included. In each patient, the test site (TS) was treated with SPPF plus EMD, whereas the control site (CS) was treated only with SPPF. Prior to surgery and at 6 months after intervention, the following parameters were evaluated: clinical attachment level (CAL), probing pocket depth (PPD), and gingival recession (GR). RESULTS: The TS and CS demonstrated a mean CAL gain of 3.31 ± 0.96 mm and 1.61 ± 1.12 mm, and a PPD reduction from 8.15 ± 0.98 to 3.00 ± 0.57 mm and 7.53 ± 0.96 to 4.69 ± 0.63 mm after 6 months, respectively. In both sites, the mean CAL gain and PPD reduction improved significantly after 6 months compared to baseline; however, the improvement was higher in the TS (p < 0.001). CONCLUSIONS: Both surgical procedures presented with clinical improvements in controlled T2DM patients. However, the additional use of EMD showed enhanced clinical results after 6 months with regard to CAL gain and PPD reduction. CLINICAL RELEVANCE: This study showed a better PPD reduction and CAL gain when an EMD was applied in addition to SPPF. Therefore, EMD may be used to enhance clinical outcomes in periodontal ID of controlled T2DM patients.
Assuntos
Perda do Osso Alveolar , Proteínas do Esmalte Dentário , Diabetes Mellitus , Retração Gengival , Perda do Osso Alveolar/cirurgia , Proteínas do Esmalte Dentário/uso terapêutico , Seguimentos , Retração Gengival/tratamento farmacológico , Retração Gengival/cirurgia , Regeneração Tecidual Guiada Periodontal/métodos , Humanos , Perda da Inserção Periodontal/tratamento farmacológico , Resultado do TratamentoRESUMO
BACKGROUND: Xenogeneic matrices (XMs) have been increasingly used for root coverage procedures. This study compared the use of two types of XM (collagen matrix [CM] and xenogeneic acellular dermal matrix [XDM]) associated with the coronally advanced flap technique (CAF) to treat single gingival recessions. METHODS: Seventy-five patients presenting single RT1 gingival recession were treated by CAF (control group, n = 25), CAF+CM (test group 1, n = 25), or CAF+XDM (test group 2, n = 25) and completed 6-month follow-up. Clinical, patient-centered, and esthetic assessments were performed and intra- and intergroup differences were analyzed. RESULTS: At 6 months, the mean recession reduction for CAF, CAF+CM, and CAF+XDM was 2.4 ± 0.8 mm, 2.4 ± 0.9 mm and 2.1 ± 0.8 mm, respectively (P > 0.05). The corresponding mean percentage of root coverage was 78.9% ± 26.2% for CAF, 78.0% ± 28.5% for CAF+CM, and 65.6% ± 26.9% for CAF+XDM (P > 0.05). Dentin hypersensitivity and esthetic conditions showed significantly improvements in all groups. Test groups presented significant gains in gingival thickness (GT; CAF+CM: 0.4 ± 0.3 mm; CAF+XDM: 0.4 ± 0.2 mm) compared to the control group (CAF: 0.0 ± 0.1 mm; P < 0.05). CONCLUSION: The CAF, CAF+CM, and CAF+XDM treatments each provided similar results in the treatment of single gingival recessions. The addition of either CM or XDM to CAF increases the GT.
Assuntos
Retração Gengival , Colágeno/uso terapêutico , Tecido Conjuntivo , Estética Dentária , Gengiva/cirurgia , Retração Gengival/tratamento farmacológico , Retração Gengival/cirurgia , Humanos , Raiz Dentária/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Evaluate the use of collagen matrix (CM) as adjunctive to coronally advanced flap (CAF versus CAF + CM) to treat gingival recession (GR) associated with non-carious cervical lesion-combined defects (CDs). METHODS: Sixty-two patients presenting 62 CDs (RT1 GR and non-carious cervical lesion (NCCLs) were randomly allocated to either CAF group (n = 31): partial restoration of the NCCL and CAF; or to CAF + CM group (n = 31): partial restoration of the NCCL and CAF associated with CM. Clinical, esthetic, patient-centered outcomes, and restorative parameters were assessed. RESULTS: After 12 months, CD coverage were 55.2% for CAF and 54.4% for CAF + CM (P = 0.8). Recession reduction were 1.9 ± 0.8 mm for CAF and 2.0 ± 0.7 mm for CAF + CM (P = 0.6). CAF+CM resulted in higher increase in keratinized tissue (KT) width (CAF: 0.3 ± 0.7 mm; CAF + CM: 0.9 ± 0.8 mm; P = 0.004) and KT thickness gain (CAF: 0.1 ± 0.3 mm; CAF + CM: 0.7 ± 0.2 mm; P = 0.001). Both treatments presented low postoperative pain and resulted in esthetics improvements. In addition, no restoration was lost, 27.4% showed a reduction of the superficial polishing, and 8% showed marginal staining, but still clinically acceptable. CONCLUSION: Partial resin composite restoration (with the apical limit up to 1 mm of the estimated CEJ) and CAF alone or combined with CM are suitable for treating CDs. The use of CM provided additional benefits in terms of KT width and thickness gain. (NCT03341598).
Assuntos
Retração Gengival , Colágeno/uso terapêutico , Tecido Conjuntivo , Estética Dentária , Seguimentos , Gengiva/patologia , Gengiva/cirurgia , Retração Gengival/tratamento farmacológico , Humanos , Raiz Dentária/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: This study aimed to evaluate, histomorphometrically, the use of collagen matrix (CM) and/or enamel matrix derivative (EMD) for the treatment of dehiscence-type recession defects in minipigs. METHODS: Eight healthy, male, young BR-1 minipigs, with no periodontal disease were treated. Bilateral dehiscence-type defects were surgically created on the buccal of the mandibular premolars (PI and PII). After 30 days, the defects were randomly assigned to four groups: coronally advanced flap (CAF); CAF + CM; CAF + EMD; and CAF + CM + EMD (split-mouth design). The evaluated parameters (mm): total defect length; new cementum (NC); new bone (NB); gingival margin position; total epithelium length; epithelium on the root; connective tissue adaptation; and soft tissue thickness (STT). RESULTS: The EMD-treated groups showed a superior length of NC [4.13 ± 1.22 (CAF + EMD); 3.95 ± 1.11 (CAF + CM + EMD); 2.94 ± 0.77 (CAF + CM); 2.72 ± 0.81 (CAF), P = 0.02] and NB [3.21 ± 0.68 (CAF + CM + EMD); 3.01 ± 0.56 (CAF + EMD); 2.15 ± 0.47 (CAF + CM); 2.29 ± 0.82 (CAF), P = 0.005]. The CAF and CAF + CM groups showed a superior epithelial length when compared to EMD-treated groups after 3 months. A superior STT was observed for CAF + CM + EMD group (1.5 ± 0.33) when compared with the other groups [1.09 ± 0.26 (CAF + EMD); 1.04 ± 0.34 (CAF + CM); and 1.14 ± 0.29 (CAF), P = 0.03]. CONCLUSION(S): The results of the present study indicate that EMD application, irrespective of the combination with CM, may improve the periodontal regeneration of dehiscence-type defects in this animal model.
Assuntos
Proteínas do Esmalte Dentário , Retração Gengival , Animais , Colágeno , Tecido Conjuntivo , Retração Gengival/tratamento farmacológico , Retração Gengival/cirurgia , Gengivoplastia , Masculino , Suínos , Porco Miniatura , Resultado do TratamentoRESUMO
Miller's class I gingival recessions (GR) have been treated using coronally advanced flap (CAF) with platelet-rich fibrin membrane (PRF membrane) or connective tissue graft (CTG). The aim of this study was to evaluate the effect of different multiple layers of PRF membranes for the treatment of GR compared with the CTG procedure. Sixty-three Miller class I GR were treated in this study. Twenty-one GR selected randomly were treated with two layers of PRF membranes+CAF in 2PRF+CAF (test group-1), four layers of PRF membranes+CAF in 4PRF+CAF (test group-2), and CTG+CAF in the control group. The plaque index (PI), gingival index (GI), probing depth (PD), keratinized tissue thickness (KTT), clinical attachment level (CAL), recession depth (RD), recession width (RW), and keratinized tissue height (KTH) measurements were performed at baseline and 1, 3, and 6 months after surgery. The post-operative discomfort of patients, assessed with the visual analog scale (VAS) and healing index (HI), was recorded after surgery. PI, GI, and PD scores were similar for all patients at all times. RD and RW scores were similar for each patient at 1 month, but these values were significantly increased in the subsequent periods in test group-1. The increase in KTT was significantly higher in the control group compared with the test groups. Similar root coverage scores were obtained in the test group-2 and control groups, and these scores were significantly higher compared with test group-1. The PRF membrane+CAF technique may be an alternative to the CTG+CAF technique for postoperative patient comfort. However, PRF membranes should use as many layers as possible.
Assuntos
Retração Gengival/tratamento farmacológico , Retração Gengival/cirurgia , Fibrina Rica em Plaquetas/química , Retalhos Cirúrgicos , Adulto , Análise de Variância , Tecido Conjuntivo/transplante , Índice de Placa Dentária , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice Periodontal , Período Pós-Operatório , Valores de Referência , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Escala Visual Analógica , Adulto JovemRESUMO
Abstract Miller's class I gingival recessions (GR) have been treated using coronally advanced flap (CAF) with platelet-rich fibrin membrane (PRF membrane) or connective tissue graft (CTG). Objective: The aim of this study was to evaluate the effect of different multiple layers of PRF membranes for the treatment of GR compared with the CTG procedure. Material and Methods: Sixty-three Miller class I GR were treated in this study. Twenty-one GR selected randomly were treated with two layers of PRF membranes+CAF in 2PRF+CAF (test group-1), four layers of PRF membranes+CAF in 4PRF+CAF (test group-2), and CTG+CAF in the control group. The plaque index (PI), gingival index (GI), probing depth (PD), keratinized tissue thickness (KTT), clinical attachment level (CAL), recession depth (RD), recession width (RW), and keratinized tissue height (KTH) measurements were performed at baseline and 1, 3, and 6 months after surgery. The post-operative discomfort of patients, assessed with the visual analog scale (VAS) and healing index (HI), was recorded after surgery. Results: PI, GI, and PD scores were similar for all patients at all times. RD and RW scores were similar for each patient at 1 month, but these values were significantly increased in the subsequent periods in test group-1. The increase in KTT was significantly higher in the control group compared with the test groups. Similar root coverage scores were obtained in the test group-2 and control groups, and these scores were significantly higher compared with test group-1. Conclusions: The PRF membrane+CAF technique may be an alternative to the CTG+CAF technique for postoperative patient comfort. However, PRF membranes should use as many layers as possible.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Retalhos Cirúrgicos , Fibrina Rica em Plaquetas/química , Retração Gengival/cirurgia , Retração Gengival/tratamento farmacológico , Período Pós-Operatório , Valores de Referência , Fatores de Tempo , Índice Periodontal , Índice de Placa Dentária , Reprodutibilidade dos Testes , Análise de Variância , Resultado do Tratamento , Estatísticas não Paramétricas , Tecido Conjuntivo/transplante , Relação Dose-Resposta a Droga , Escala Visual Analógica , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Gingival recession (GR) might be associated with patient discomfort due to cervical dentin hypersensitivity (CDH) and esthetic dissatisfaction. The aim is to evaluate the effect of root coverage procedure with a xenogenous collagen matrix (CM) and/or enamel matrix derivative (EMD) in combination with a coronally advanced flap (CAF) on CDH, esthetics, and oral health-related quality of life (OHRQoL) of patients with GR. METHODS: Sixty-eight participants with single Miller Class I/II GRs were treated with CAF (n = 17), CAF + CM (n = 17), CAF + EMD (n = 17), and CAF + CM + EMD (n = 17). CDH was assessed by evaporative stimuli using a visual analog scale (VAS) and a Schiff scale. Esthetics outcome was assessed with VAS and the Questionnaire of Oral Esthetic Satisfaction. Oral Health Impact Profile-14 (OHIP-14) questionnaire was used to assess OHRQoL. All parameters were evaluated at baseline and after 6 months. RESULTS: Intragroup analysis showed statistically significant reduction in CDH and esthetic dissatisfaction with no intergroup significant differences (P >0.05). The impact of oral health on QoL after 6 months was significant for CAF + CM, CAF + EMD, and CAF + CM + EMD (P <0.05). Total OHIP-14 score and psychologic discomfort, psychologic disability, social disability, and handicap dimensions showed negative correlation with esthetics. OHIP-14 physical pain dimension had positive correlation with CDH (P <0.05). OHIP-14 showed no correlation with percentage of root coverage, keratinized tissue width, or keratinized tissue thickness (P >0.05). CONCLUSION: Root coverage procedures improve patient OHRQoL by impacting on a wide range of dimensions, perceived after reduction of CDH and esthetic dissatisfaction of patients with GRs treated with CAF + CM, CAF + EMD, and CAF + CM + EMD.
Assuntos
Colágeno/uso terapêutico , Esmalte Dentário/transplante , Retração Gengival/terapia , Satisfação do Paciente , Adolescente , Adulto , Terapia Combinada , Método Duplo-Cego , Estética Dentária , Feminino , Retração Gengival/tratamento farmacológico , Retração Gengival/cirurgia , Gengivoplastia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Considering xenogeneic collagen matrix (CM) and enamel matrix derivative (EMD) characteristics, it is suggested that their combination could promote superior clinical outcomes in root coverage procedures. Thus, the aim of this parallel, double-masked, dual-center, randomized clinical trial is to evaluate clinical outcomes after treatment of localized gingival recession (GR) by a coronally advanced flap (CAF) combined with CM and/or EMD. METHODS: Sixty-eight patients presenting one Miller Class I or II GRs were randomly assigned to receive either CAF (n = 17); CAF + CM (n = 17); CAF + EMD (n = 17), or CAF + CM + EMD (n = 17). Recession height, probing depth, clinical attachment level, and keratinized tissue width and thickness were measured at baseline and 90 days and 6 months after surgery. RESULTS: The obtained root coverage was 68.04% ± 24.11% for CAF; 87.20% ± 15.01% for CAF + CM; 88.77% ± 20.66% for CAF + EMD; and 91.59% ± 11.08% for CAF + CM + EMD after 6 months. Groups that received biomaterials showed greater values (P <0.05). Complete root coverage (CRC) for CAF + EMD was 70.59%, significantly superior to CAF alone (23.53%); CAF + CM (52.94%), and CAF + CM + EMD (51.47%) (P <0.05). Keratinized tissue thickness gain was significant only in CM-treated groups (P <0.05). CONCLUSIONS: The three approaches are superior to CAF alone for root coverage. EMD provides highest levels of CRC; however, the addition of CM increases gingival thickness. The combination approach does not seem justified.
Assuntos
Colágeno/uso terapêutico , Esmalte Dentário/transplante , Retração Gengival/terapia , Adolescente , Adulto , Terapia Combinada , Método Duplo-Cego , Feminino , Retração Gengival/tratamento farmacológico , Retração Gengival/cirurgia , Gengivoplastia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: The aim of this systematic review is to evaluate the effects of platelet-rich fibrin (PRF) membranes on the outcomes of clinical treatments in patients with gingival recession. METHODS: Articles that were published before June 2015 were searched electronically in four databases without any date or language restrictions and searched manually in regular journals and unpublished studies. The eligibility criteria comprised randomized controlled trials (RCTs) and prospective controlled trials with follow-up periods of ≥ 6 months that compared the performance of PRF to other biomaterials in the treatment of Miller Class I or II gingival recessions. For the meta-analysis, the inverse variance method was used in fixed- or random-effect models, which were chosen according to heterogeneity. The estimates of the intervention effects were expressed as the mean differences in percentages or millimeters. RESULTS: Six RCTs and one prospective clinical trial are included in this review. Root coverage (RC) and clinical attachment level (CAL) did not differ significantly between the analyzed subgroups (P = 0.57 and P = 0.50, respectively). The keratinized mucosa width (KMW) gain was significantly greater (P = 0.04) in the subgroup that was treated with connective tissue grafts. CONCLUSION: The results of the meta-analysis suggest that the use of PRF membranes did not improve the RC, KMW, or CAL of Miller Class I and II gingival recessions compared with the other treatment modalities.
Assuntos
Retração Gengival , Plaquetas , Tecido Conjuntivo , Fibrina/uso terapêutico , Gengiva , Retração Gengival/tratamento farmacológico , Humanos , Estudos Prospectivos , Retalhos Cirúrgicos , Resultado do TratamentoRESUMO
AIM: The goal of this study was to evaluate if a biological hydrogel of recombinant human Fibroblast Growth Factor type 2 (rhFGF-2) in a hyaluronic acid (HA) carrier applied in periodontal intrabony defects would enhance the clinical parameters of regeneration of the periodontal attachment apparatus MATERIALS AND METHODS: Thirty adult patients were evaluated. Two intrabony defects present in contra-lateral quadrants in each patient were randomly allocated for each of the treatment methods employed. Control group (n = 30) were treated by open debridement with the papilla preservation flaps, while the test group (n = 30) also received a topical application of rhFGF-2/HA in the intrabony defect. The parameters evaluated, at baseline and after one year, were, were probing depth (PD), gingival recession (REC), probing attachment level (PAL) and probing bone level (PBL). The primary outcome measures was PAL gain RESULTS: Test sites exhibited significantly more PD reduction (5.5 versus 2.9 mm), PAL gains (4.8 versus 2.2 mm) and shallower residual PD (4.2 versus 6.6 mm) than controls. Moreover, residual PD smaller than 5 mm (100 versus 0%) and PAL gain > 4 mm (60 versus 20%) was significantly more frequent in the test group CONCLUSION: Application of rhFGF-2/HA significantly improved clinical parameters of periodontal wound healing one year after treatment.
Assuntos
Perda do Osso Alveolar/tratamento farmacológico , Regeneração Óssea/efeitos dos fármacos , Fator 2 de Crescimento de Fibroblastos/uso terapêutico , Ácido Hialurônico/química , Adulto , Idoso , Processo Alveolar/efeitos dos fármacos , Periodontite Crônica/tratamento farmacológico , Desbridamento/métodos , Portadores de Fármacos , Feminino , Seguimentos , Retração Gengival/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Perda da Inserção Periodontal/tratamento farmacológico , Bolsa Periodontal/tratamento farmacológico , Estudos Prospectivos , Radiografia Dentária Digital/métodos , Proteínas Recombinantes , Retalhos Cirúrgicos/cirurgia , Resultado do TratamentoRESUMO
The aim of this study was to investigate the adjunctive effect of antimicrobial photodynamic therapy (aPDT) to scaling and root planing (SRP) in smokers with chronic periodontitis. Twenty subjects had two contralateral teeth randomly assigned to receive SRP (SRP group) or SRP + a single episode of aPDT (SRP + aPDT group), with a diode laser and a phenothiazine photosensitizer. Plaque index, bleeding on probing, probing depth (PD), clinical attachment level (CAL), and gingival recession were recorded, and gingival crevicular fluid was collected for assay of IL-1ß and matrix metalloproteinase (MMP)-8 levels. There was a significant PD reduction (SRP 1.81 ± 0.52 mm/SRP + aPDT 1.58 ± 1.28 mm; p < 0.001) and a significant CAL gain (SRP 1.60 ± 0.92 mm/SRP + aPDT 1.41 ± 1.58 mm; p < 0.001) for both groups. Significant differences were not observed in between-group comparisons. IL-1ß level in gingival crevicular fluid was higher in SRP group after 1 week (SRP 24.65 ± 18.85 pg/µL/SRP + aPDT 34.07 ± 24.81 pg/µL; p = 0.048), and MMP-8 level was higher in SRP group after 12 weeks (SRP 303.31 ± 331.62 pg/µL/SRP + aPDT 534.23 ± 647.37 pg/µL; p = 0.024). There were no statistically significant differences in intragroup comparisons. The adjunctive effect of aPDT did not warrant improvements on clinical parameters in smokers. However, it resulted in a suppression of IL-1ß and MMP-8 when compared with SRP alone.
Assuntos
Anti-Infecciosos/administração & dosagem , Periodontite/terapia , Fotoquimioterapia/métodos , Aplainamento Radicular/métodos , Fumar/efeitos adversos , Adulto , Periodontite Crônica/terapia , Terapia Combinada/métodos , Índice de Placa Dentária , Raspagem Dentária/métodos , Feminino , Líquido do Sulco Gengival/metabolismo , Retração Gengival/tratamento farmacológico , Humanos , Interleucina-1beta/metabolismo , Lasers Semicondutores/uso terapêutico , Masculino , Metaloproteinase 8 da Matriz/metabolismo , Pessoa de Meia-Idade , Fármacos Fotossensibilizantes/uso terapêuticoRESUMO
AIM: The aim of this randomized controlled clinical study was to compare the use of an acellular dermal matrix graft (ADMG) with or without the enamel matrix derivative (EMD) in smokers to evaluate which procedure would provide better root coverage. MATERIAL AND METHODS: Nineteen smokers with bilateral Miller Class I or II gingival recessions ≥3 mm were selected. The test group was treated with an association of ADMG and EMD, and the control group with ADMG alone. Probing depth, relative clinical attachment level, gingival recession height, gingival recession width, keratinized tissue width and keratinized tissue thickness were evaluated before the surgeries and after 6 months. Wilcoxon test was used for the statistical analysis at significance level of 5%. RESULTS: No significant differences were found between groups in all parameters at baseline. The mean gain recession height between baseline and 6 months and the complete root coverage favored the test group (p = 0.042, p = 0.019 respectively). CONCLUSION: Smoking may negatively affect the results achieved through periodontal plastic procedures; however, the association of ADMG and EMD is beneficial in the root coverage of gingival recessions in smokers, 6 months after the surgery.
Assuntos
Proteínas do Esmalte Dentário/uso terapêutico , Retração Gengival/tratamento farmacológico , Retração Gengival/cirurgia , Gengivoplastia/métodos , Pele Artificial , Fumar , Adulto , Distribuição de Qui-Quadrado , Colágeno , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Estatísticas não ParamétricasRESUMO
The primary aim of this randomized clinical investigation was to evaluate gingival recession defects treated by a coronally advanced flap and sub-epithelial connective tissue graft (SCTG) with or without enamel matrix derivative (EMD). Twelve patients with Miller's class III buccal recession defects of ≥2.0 mm in similar contra lateral sites were included in this split-mouth randomized study. Test sites were treated with SCTG plus EMD while control sites received SCTG only. At baseline, 6 months and 12 months, clinical parameters such as recession level (RL), probing depth (PD), clinical attachment level (CAL), and apico-cervical width of keratinized tissue (KT) were determined. A P value <0.05 was considered significant. Compared to the baseline and based on paired t tests, both groups had significant improvement in all the clinical parameters. However, the test group showed better results in RL (P = 0.046) and CAL (P = 0.023) at 6 months. At 12 months, the test group demonstrated better results in RL (P = 0.01), PD (P = 0.017) and CAL (P = 0.001). Only the KT results were not significantly different between groups at both 6 and 12 months (P = 0.708) and (P = 0.570), respectively. The present study demonstrated the benefit of adding EMD to SCTG for root coverage in Miller's class III buccal gingival recession defects after 12 months. (J Oral Sci 52, 463-471, 2010).
Assuntos
Tecido Conjuntivo/transplante , Proteínas do Esmalte Dentário/uso terapêutico , Retração Gengival/tratamento farmacológico , Retração Gengival/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The purpose of this review is to evaluate the effectiveness of different root-coverage procedures in the treatment of recession-type defects. METHODS: The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched for entries up to October 2008. There were no restrictions regarding publication status or the language of publication. Only clinical randomized controlled trials (RCTs) with a duration > or = 6 months that evaluated recession areas (Miller Class I or II > or = 3 mm) that were treated by means of periodontal plastic surgery procedures were included. RESULTS: Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias. The results indicated a significantly greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTGs) compared to guided tissue regeneration (GTR) with bioabsorbable membranes (GTR bms). A significantly greater gain in keratinized tissue was found for enamel matrix protein compared to a coronally advanced flap (0.40 mm) and for SCTGs compared to GTR bms plus bone substitutes. Limited data exist on the changes of esthetic conditions as related to the opinions and preferences of patients for specific procedures. CONCLUSIONS: SCTGs, coronally advanced flaps alone or associated with other biomaterial, and GTR may be used as root-coverage procedures for the treatment of localized recession-type defects. In cases where root coverage and gain in keratinized tissue are expected, the use of SCTGs seems to be more adequate.
Assuntos
Retração Gengival/cirurgia , Colágeno , Tecido Conjuntivo/transplante , Proteínas do Esmalte Dentário/uso terapêutico , Retração Gengival/tratamento farmacológico , Gengivoplastia/métodos , Regeneração Tecidual Guiada Periodontal , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Retalhos CirúrgicosRESUMO
PURPOSE: To evaluate the influence of tetracycline gel, brushed on tooth surfaces, on periodontal clinical parameters following root debridement. METHODS: 20 subjects diagnosed with chronic periodontitis and presenting a minimum of two proximal sites on anterior teeth (maxillary or mandibular) with probing depth +/- 5 mm, were selected. Following oral hygiene instructions and ultrasonic supragingival instrumentation, subjects were assigned to one of the following groups: RDS--root debridement with Gracey curettes and root brushing with saline solution; and RDT--root debridement with Gracey curettes and root brushing with 40% tetracycline gel. Full-thickness flaps were reflected and instrumentation was performed using a clinical microscope to optimize calculus detection. Probing depth (PD), relative gingival margin level (RGML) and relative attachment level (RAL) measures were registered at five visits: baseline and days 30, 60, 90 and 120 postoperative. RESULTS: Both approaches were able to markedly reduce the PD values from baseline in all periods (P < 0.0001). No differences were found for RAL values in any of the groups. No differences were found between groups. In conclusion, the application of tetracycline gel does not seem to provide any additional improvement on clinical periodontal parameters after root debridement.
Assuntos
Antibacterianos/uso terapêutico , Periodontite/terapia , Curetagem Subgengival , Tetraciclina/uso terapêutico , Administração Tópica , Adulto , Antibacterianos/administração & dosagem , Terapia Combinada , Raspagem Dentária , Feminino , Seguimentos , Géis , Retração Gengival/tratamento farmacológico , Retração Gengival/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Higiene Bucal , Perda da Inserção Periodontal/tratamento farmacológico , Perda da Inserção Periodontal/terapia , Bolsa Periodontal/tratamento farmacológico , Bolsa Periodontal/terapia , Periodontite/tratamento farmacológico , Aplainamento Radicular , Retalhos Cirúrgicos , Tetraciclina/administração & dosagem , Raiz Dentária/efeitos dos fármacos , Raiz Dentária/patologia , Terapia por UltrassomRESUMO
AIM: To assess the effect of systemic azithromycin as a supplement to scaling and root planing (SRP) in the treatment of aggressive periodontitis (AgP). MATERIAL AND METHODS: Twenty-four individuals (13-26 years old) underwent a plaque control program, and then were treated with SRP. Subjects were assigned randomly into two groups; the test group used 500 mg azithromycin once a day for 3 days, whereas the control group used a placebo. Clinical variables were assessed at baseline, 3, 6, 9, and 12 months. The periodontal status at baseline and 12 months was compared using the Wald test, and adjusting for the effect of clustering of teeth within subjects. RESULTS: There were no significant differences in visible plaque, gingival bleeding, and supragingival calculus between groups throughout the study. Periodontal probing depth (PPD) and clinical attachment level improved significantly from baseline to 12 months in both groups, with the test group showing significantly more reduction in mean PPD compared with controls (2.88 mm versus 1.85 mm, respectively, p=0.025). Subjects administering azithromycin showed a higher percentage of teeth with attachment gain >or=1 mm (81.34 versus 63.63, p=0.037), whereas the controls had higher percentage of teeth with attachment loss >or=1 mm (11.57 versus 2.24, p=0.015). CONCLUSIONS: The adjunctive use of azithromycin has the potential to improve periodontal health of young patients with AgP.
Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Periodontite/tratamento farmacológico , Adolescente , Adulto , Terapia Combinada , Cálculos Dentários/prevenção & controle , Placa Dentária/prevenção & controle , Raspagem Dentária , Método Duplo-Cego , Feminino , Seguimentos , Hemorragia Gengival/tratamento farmacológico , Hemorragia Gengival/terapia , Retração Gengival/tratamento farmacológico , Retração Gengival/terapia , Humanos , Masculino , Perda da Inserção Periodontal/tratamento farmacológico , Perda da Inserção Periodontal/terapia , Bolsa Periodontal/tratamento farmacológico , Bolsa Periodontal/terapia , Periodontite/terapia , Placebos , Aplainamento Radicular , Curetagem SubgengivalRESUMO
The objective of this split-mouth, double-blind, randomized controlled trial was to compare the clinical effect of treatment of 2- or 3-wall intrabony defects with open flap debridement (OFD) combined or not with enamel matrix proteins (EMP). Thirteen volunteers were selected with one pair of or more intrabony defects and probing pocket depth (PPD) > or = 5 mm. All individuals received instructions regarding oral hygiene and were submitted to scaling and root planing. Each participant received the two treatment modalities: test sites were treated with OFD and EMP, and control sites received only OFD. After 6 months, a significant reduction was observed in PPD for the EMP group (from 6.42 +/- 1.08 mm to 2.67 +/- 1.15 mm) and for the OFD group (from 6.08 +/- 1.00 mm to 2.00 +/- 0.95 mm) (p < 0.0001), but with no significant difference between groups (p = 0.13). A significant gain in relative attachment level (RAL) was observed in both groups (EMP: from 13.42 +/- 1.88 mm to 10.75 +/- 2.26 mm, p < 0.001; OFD: from 12.42 +/- 1.98 mm to 10.58 +/- 2.23 mm, p = 0.013), but with no significant difference between groups (p = 0.85). Gingival recession (GR) was higher in the EMP group (from 1.08 +/- 1.50 mm to 2.33 +/- 1.43 mm; p = 0.0009) than in the OFD group (from 0.66 +/- 1.15 mm to 1.16 +/- 1.33 mm; p = 0.16), but this difference was not significant (p = 0.06). In conclusion, the results showed that OFD combined with EMP was not able to improve treatment of intrabony defects compared to OFD alone.
Assuntos
Perda do Osso Alveolar/tratamento farmacológico , Perda do Osso Alveolar/cirurgia , Regeneração Óssea/efeitos dos fármacos , Desbridamento , Proteínas do Esmalte Dentário/farmacologia , Retalhos Cirúrgicos , Adulto , Terapia Combinada/métodos , Proteínas do Esmalte Dentário/uso terapêutico , Índice de Placa Dentária , Método Duplo-Cego , Feminino , Seguimentos , Retração Gengival/tratamento farmacológico , Retração Gengival/cirurgia , Humanos , Masculino , Perda da Inserção Periodontal/tratamento farmacológico , Perda da Inserção Periodontal/cirurgia , Raiz Dentária/efeitos dos fármacosRESUMO
The objective of this split-mouth, double-blind, randomized controlled trial was to compare the clinical effect of treatment of 2- or 3-wall intrabony defects with open flap debridement (OFD) combined or not with enamel matrix proteins (EMP). Thirteen volunteers were selected with one pair of or more intrabony defects and probing pocket depth (PPD) > 5 mm. All individuals received instructions regarding oral hygiene and were submitted to scaling and root planing. Each participant received the two treatment modalities: test sites were treated with OFD and EMP, and control sites received only OFD. After 6 months, a significant reduction was observed in PPD for the EMP group (from 6.42 ± 1.08 mm to 2.67 ± 1.15 mm) and for the OFD group (from 6.08 ± 1.00 mm to 2.00 ± 0.95 mm) (p < 0.0001), but with no significant difference between groups (p = 0.13). A significant gain in relative attachment level (RAL) was observed in both groups (EMP: from 13.42 ± 1.88 mm to 10.75 ± 2.26 mm, p < 0.001; OFD: from 12.42 ± 1.98 mm to 10.58 ± 2.23 mm, p = 0.013), but with no significant difference between groups (p = 0.85). Gingival recession (GR) was higher in the EMP group (from 1.08 ± 1.50 mm to 2.33 ± 1.43 mm; p = 0.0009) than in the OFD group (from 0.66 ± 1.15 mm to 1.16 ± 1.33 mm; p = 0.16), but this difference was not significant (p = 0.06). In conclusion, the results showed that OFD combined with EMP was not able to improve treatment of intrabony defects compared to OFD alone.
O objetivo deste estudo clínico controlado, randomizado, duplo-cego, tipo boca-dividida foi comparar o efeito clínico do tratamento de defeitos infra-ósseos de 2 ou 3 paredes com retalho de espessura total (RET) associado ou não com a proteína da matriz do esmalte (PME). Treze voluntários com 1 par ou mais de defeitos infra-ósseos foram selecionados com profundidade clínica de sondagem (PCS) > 5 mm. Todos receberam instruções de higiene bucal, raspagem e alisamento radicular. Cada participante recebeu os dois tipos de tratamento: o lado teste foi tratado com RET e PME, e o lado controle recebeu somente RET. Após 6 meses, foi observada uma redução significante na PCS para o grupo PME (de 6,42 ± 1,08 mm para 2,67 ± 1,15 mm) e para o grupo RET (de 6,08 ± 1,00 mm para 2,00 ± 0,95 mm) (p < 0,0001), mas não houve diferença significante entre os grupos (p = 0,13). Um ganho significante de nível clínico de inserção relativo (NCIR) foi observado em ambos os grupos (PME: de 13,42 ± 1,88 mm para 10,75 ± 2,26 mm, p < 0,001; RET: de 12,42 ± 1,98 mm para 10,58 ± 2,23 mm, p = 0,013), mas não houve diferença significante entre os grupos (p = 0,85). A retração gengival (RG) foi maior para o grupo PME (de 1,08 ± 1,50 mm para 2,33 ± 1,43 mm; p = 0,0009) do que para o grupo RET (de 0,66 ± 1,15 mm para 1,16 ± 1,33 mm; p = 0,16), mas essa diferença não foi significante (p = 0,06). Concluiu-se que o tratamento de defeitos infra-ósseos com RET associado à PME não mostrou resultados melhores que o uso de RET sozinho.
Assuntos
Adulto , Feminino , Humanos , Masculino , Perda do Osso Alveolar/tratamento farmacológico , Perda do Osso Alveolar/cirurgia , Regeneração Óssea/efeitos dos fármacos , Desbridamento , Proteínas do Esmalte Dentário/farmacologia , Retalhos Cirúrgicos , Terapia Combinada/métodos , Índice de Placa Dentária , Método Duplo-Cego , Proteínas do Esmalte Dentário/uso terapêutico , Seguimentos , Retração Gengival/tratamento farmacológico , Retração Gengival/cirurgia , Perda da Inserção Periodontal/tratamento farmacológico , Perda da Inserção Periodontal/cirurgia , Raiz Dentária/efeitos dos fármacosRESUMO
BACKGROUND: The aim of this clinical study was to evaluate the association of locally delivered doxycycline 10% with scaling and root planing in the periodontal treatment of smokers during a 2-year period. METHODS: Forty-eight chronic periodontitis patients, presenting a minimum of four pockets (>or=5 mm) that bled on probing on anterior teeth were included. Patients were randomly assigned to receive one of the following treatments: scaling and root planing (SRP) and scaling and root planing followed by local application of doxycycline (SRP-D). Assigned treatments were performed at baseline and at 12 months. Clinical parameters, including probing depth (PD) and relative attachment level (RAL), were recorded at baseline; 45 days; 3, 6, and 12 months (retreatment); 45 days following retreatment; and at 15, 18, and 24 months. RESULTS: In initially deep pockets (>or=7 mm), SRP-D showed greater PD reduction than SRP at 6 and 18 months (mean difference between groups of 1.18 and 1.73 mm, respectively; P <0.05) and greater RAL gain in all periods after 3 months (mean difference between groups of 1.16, 1.99, and 1.78 mm, at 6, 18, and 24 months, respectively; P <0.05). Also, the proportion of sites showing >or=2 mm PD reduction was greater for SRP-D at 6 months (81.2% x 50.8%; P <0.001) and at 24 months (65.5% x 46.5%; P = 0.01). As for RAL gain, this proportion was 34.4% and 18.1% for SRP-D and SRP at 24 months, respectively (P = 0.008). CONCLUSION: The use of locally delivered doxycycline may constitute an important adjunct for the active and supportive treatments of severe periodontal disease in smokers.