Objective The purpose of this study was to evaluate the impact of orthodontic movement on clinical, microbiological, and tomographic parameters in patients with a history of periodontitis. Materials and Methods Twelve individuals (2 males and 10 females, mean age 42.1 years) who had undergone treatment for generalized chronic periodontitis were selected from the Periodontal Clinic of Guarulhos University (Brazil). The patients undergoing orthodontic treatment were submitted to a clinical examination, and cone beam computed tomography scans were performed at baseline and after 12 months of treatment. Subgingival biofilm samples were analyzed by checkerboard DNA-DNA hybridization. Statistical analysis was performed by a Wilcoxon test. Results With regard to the periodontal clinical parameters, when comparing baseline and 12-month evaluations, statistically significant reductions were found in Probing Depth and Clinical Attachment Level (CAL). There was a statistically significant increase in the number of sites that had lost CAL. There were no statistically significant tomographic differences, and no loss in the buccal alveolar bone thickness was detected. Conclusions Considering clinical periodontal parameters, a reduction was observed in the number and percentage of CAL. There was a reduction in A. gerencseriae and an increase in F. nuc. nucleatum, S. constellatus, and T. Forsythia species. Regarding the tomographic parameters, no statistically significant differences were observed.
Objective The aim of the present study was to compare the efficacy of bone tacks and sutures in free gingival graft FGG stabilization during gingival augmentation procedures. Materials and Methods Twelve subjects participated in this study. One site in each subject was randomly assigned into each of the following experimental groups. In the test group, the FGG was stabilized with bone tacks whereas FGG procedure with conventional sutures was performed in the control group. Clinical parameters assessed were the width of keratinized gingiva and plaque index PI scores at baseline 1 month and 3 months. Surface shrinkage SS was recorded at 15 days 1 month and 3 months. Early wound healing score EHS was recorded postoperatively after an interval of 1 week. Results Bone tacks stabilized with FGG were effective in increasing the width of the keratinized gingiva but did not show any added advantage over sutures with no statistical difference between both groups p0.49. In both groups there was similar SS EHS and PI scores with no statistical significance difference between them p1.00. Conclusion This trial was conducted over a period of 3 months and it was observed that bone tacks can be used to stabilize the FGG during mucogingival procedures.
Objective: To assess the effectiveness of using aqueous and gaseous ozone in the gingival tissues of periodontitis patients. Materials and Methods: Two independent reviewers searched electronic databases (Lilacs, PubMed, Scopus, and Web of Science) using keywords specific to the topic. The variables extracted from each selected article included: type of study, sample size, population, periodontal parameters, and age. The eligibility criteria included randomized clinical trials analyzing the effectiveness of ozone (aqueous or gaseous) as an adjunct to periodontal treatment. Results: After applying the inclusion and exclusion criteria, 1,203 articles were initially selected from the databases. From 926 studies selected by the title, 11 articles were considered appropriate for the present study, with the majority being classified with a low risk of bias. It was found that the two forms of ozone (aqueous and gaseous) provided clinical benefits to the treatment of periodontitis, but aqueous ozone is safer regarding toxicity. Conclusion: Given the results obtained, when compared to a negative control group, aqueous ozone was superior, and when compared to chlorhexidine (CHX), aqueous ozone had similar effects as adjunct in the periodontal treatment. Clinical relevance: Using aqueous ozone can help to safely eliminate bacterial pathogens, improving the periodontal treatment, without side effects, compared to CHX.
Objective: The present prospective randomized clinical study compared the use of Dermabond® tissue adhesive as a substitute for sutures in free gingival graft fixation. Materials and Methods: Twenty individuals with absence of keratinized mucosa (KM) or KM height less than 1.0 mm in the buccal area of the mandibular incisors were selected to receive free gingival grafts. The patients were distributed into two groups: G1, composed of 8 patients with 10-mm grafts fixed with sutures; G2, composed of 10 patients with 10-mm grafts fixed with Dermabond®. All grafts had the same height (5mm) and thickness (1mm). Bleeding on probing, probing depth, gingival recession, keratinized mucosa height, attached keratinized mucosa height, and clinical attachment level were measured at 0, 15, 30, 45, 90, and 180 days. Results: ANOVA test showed significantly smaller graft contraction and significant increase in attached keratinized mucosa (p < 0.05) in G2, compared to G1. Additionally, G2 exhibited significant clinical root coverage (p < 0.05). Conclusions: The free gingival grafts fixed with Dermabond® tissue adhesive presented a faster clinical surgery, better dimensional stability, clinical root coverage, and did not alter the clinical healing process.
ChatGPT Introduction: Necrotizing periodontal diseases (NPD) are acute lesions with a rapid onset that may cause considerable periodontal tissue destruction. Among these conditions, necrotizing gingivitis (NG) is caused by microorganisms from the oral biofilm and is associated with predisposing factors such as psychological stress, HIV/AIDS, alcohol and tobacco consumption, malnutrition, inadequate oral hygiene, and other systemic conditions that may compromise the host immune response. Objective: The aim of this narrative literature review was to describe the available evidence on the diagnosis and treatment of NG and present a successfully treated case of NG in a 22-year-old woman. Case report: The patient was a smoker, had poor oral hygiene, and was experiencing psychological stress. Her complaints were abundant gingival bleeding and halitosis during the past two weeks preceding the first appointment. Clinical findings included considerable biofilm accumulation, generalized gingival bleeding, pseudomembrane, and necrotic tissue. Treatment consisted of supragingival scaling, professional prophylaxis, 0.12% chlorhexidine rinsing for two weeks, prescription of analgesics, and oral hygiene instructions. Results: The patient’s response to initial therapy was satisfactory. Successful clinical outcomes were observed at seven days after initial therapy, and the patient has remained stable without signs of disease recurrence for six months. Conclusion: Periodontal health and function were successfully reestablished.
Introduction: Excessive gingival display (EGD), often referred to as a gummy smile, ranks among the most common concerns expressed by patients seeking enhanced aesthetic appeal in their smiles. Various treatment modalities are available for addressing this issue, including gingivectomy with or without osteotomy, crown lengthening, botulinum toxin injections, lip repositioning surgery, and orthognathic surgery—often accompanied by orthodontic intervention, contingent upon the underlying cause. A relatively recent addition to this repertoire involves the use of a polymethylmethacrylate-based (PMMA) cement to fill the subnasal depression, aiming to restrict lip movement and reposition the upper lip to reduce gingival exposure. Objective: This article presents a clinical case with a 12-month follow-up, wherein PMMA cement was utilized to address the subnasal depression in conjunction with crown lengthening to resolve EGD in a patient.
Objective: The aim of the present in vitro study was to evaluate the efficacy of phthalocyanine dye in photodynamic therapy (PDT) as an adjunct to mechanical debridement in the management of peri-implantitis. Methods: S. aureus, F. nucleatum, and P. gingivalis were coated on titanium (Ti) discs and divided into control and test groups. In the control group, mechanical debridement + laser was performed, while in the test group, PDT with hydroxyaluminium phthalocyanine (AIPcOH) dye as photosensitizer was used. Bacterial colony counts and surface hardness were assessed post-operatively. Results: There was a significant difference in the bacterial count reduction at different time intervals in the test group (p=0.01) compared to the control group; no significant difference was observed in surface hardness (p=0.7). Conclusion: This present in vitro study concluded that PDT with AIPcOH dye was effective in eradicating S. aureus, F. nucleatum, and P. gingivalis on Ti discs. This study also concluded that PDT with a photosensitizer can be used as an adjunct in the management of peri-implantitis.
Objective: This study aimed to evaluate self-esteem and patient’s satisfaction before and after surgical correction of altered passive eruption (APE) type 1B in the anterior maxilla, in a three and 18-months follow-up; and postoperative pain and discomfort. Materials and Methods: Twelve individuals (mean age 23.3±4.2 years) were submitted to gingivoplasty, osteoplasty, and osteotomy, and answered questionnaires including the Visual Analog Scale (0-10). Results: At baseline, patients expressed that esthetics, in general, had a high importance in their lives (8.0±1.3), as well as smile esthetics (8.5±1.6). Self-esteem improved from baseline (3.6±2.4), compared to the 3rd (9.3±0.8) and 18th month (9.1±0.6) (p<0.001). Satisfaction with the smile increased from baseline (4.1±3.1) up to the 3rd (9.5±0.6) and 18th postoperative month (9.4±0.5) (p=0.002). At the 3rd day after surgery, pain decreased significantly (4.1±2.8 to 0.7±1.2, p=0.001), and discomfort remained mild (2.7±2.4 to 0.6±0.8, p>0.05). Correlation analysis revealed that the greater the aesthetic demand of the patient at baseline, the greater was the increase in self-esteem (correlation coefficient >0.9, p<0.001). Conclusion: In the present study, surgical procedure led to an improvement in patient’s self-esteem and satisfaction with the smile’s aesthetics, which was maintained up to the 18th month of follow-up. Pain and discomfort reached a mild degree in the first three postoperative days.
Objective: This clinical case report aims to demonstrate a successful treatment using an alternative technique for flapless immediate implant placement by letting the xenogeneic bone graft exposed to the oral environment. Case report: A flapless immediate implant placement into the fresh mandibular first molar socket was done. The alveolar gap was filled by deproteinized bovine bone mineral (DBBM) up to the level of the gingival margin, and the biomaterial was intentionally left exposed and maintained only by the cover screw. A definitive restoration was placed six months after the implant insertion. This patient exhibited no clinical or radiologic complications throughout the six-year follow-up period. Conclusion: The DBBM exposed to the oral environment showed stability and caused no sign of infection and clinical complications. Throughout the follow-up time, the patient presented a favorable peri-implant phenotype, with a wide keratinized mucosa width, stable peri-implant buccal bone, as well as the maintenance of crestal bone. Although the exposed biomaterial may be more susceptible to displacement, this approach showed satisfactory performance regarding uneventful healing, esthetics, and function, in a six-year follow-up. However, randomized clinical trials to evaluate the clinical predictability and soft and hard tissues healing profile are needed.
Objective: To assess levels of the biomarkers Plasminogen Activator Inhibitor-1 (PAI-1) and alpha 2-macroglobulin (2MG) in saliva and serum in healthy individuals and patients with and without type 2 diabetes mellitus (T2DM) before and after periodontal therapy. Materials and Methods: The 90 recruited subjects were divided into the three following groups: Group 1, with 30 healthy subjects; Group 2, with 30 systemically healthy subjects with stage II and III periodontitis; and Group 3, with 30 patients with periodontitis and well-controlled T2DM (PDM). Salivary and serum PAI-1 and α2MG levels were estimated by enzyme-linked immunosorbent assay and correlated with clinical parameters before and three months after periodontal therapy, and the data obtained was statistically analyzed. Results: There was an improvement in clinical parameters in both groups that underwent initial periodontal therapy. Salivary and serum PAI-1 and α2MG levels were upregulated in PDM group, compared to periodontitis alone at baseline. A significant reduction in the levels of the biomarkers was observed three months after periodontal therapy, and an improvement in glycaemic control was also seen in the PDM group. Conclusion: PAI-1 was expressed in saliva and serum in healthy patients, and increased in periodontitis and diabetes patients, thus evidencing its possible role in periodontal inflammation and glucose regulation, and its levels decreased after periodontal therapy.
Objective: The aim of the study was to evaluate the efficacy of calcium phosphosilicate bioactive glass in combination with Platelet Rich Fibrin (PRF) in the treatment of horizontal bone defects in stages II and III periodontitis. Materials and Methods: The randomized controlled trial included 51 sites of horizontal bone defects from 4 patients with stages II and III periodontitis. The three treatment groups were: Group A - open flap debridement (OFD) + bone graft + PRF gel; Group B - OFD + bone graft + PRF gel covered by PRF membrane; Group C - OFD alone. The clinical and radiographic parameters were recorded at baseline and 9 months post-surgery. Results: All three groups showed statistically significant improvement in clinical and radiographic parameters, except for defect width at 9 months post-surgery. Conclusion: The findings of the present study allow us to conclude that the use of PRF in combination with bone graft can serve as a promising therapeutic approach for the treatment of horizontal bone defects, resulting in improvement of both clinical and radiographic parameters.
Abstract Objective: To determine the effects of laser and photodynamic therapy (PDT) on crevicular procalcitonin (PCT) and red complex bacteria in patients with periodontitis stage II grade A. Methods: Sixty-six sites with periodontitis were selected. After scaling and root planing (SRP), participants were randomized to receive 810-nm diode laser and PDT using indocyanine green (ICG). The primary outcome was the change in crevicular PCT levels and red complex bacterial loads measured using the BAPNA assay. Secondary outcomes included probing depth (PPD), clinical attachment loss (CAL), relative attachment level (RAL), plaque index, and gingival index, assessed at baseline and 3 months post-intervention. Results: Significant improvements (P < 0.001) were observed for all variables within each group at the 3-month follow-up compared to baseline. Among the treatment groups, SRP+ICG-PDT demonstrated a greater reduction in BAPNA and PCT levels compared to SRP+laser and SRP alone. Correlation analysis between BAPNA and PCT revealed a significant positive correlation (r = 0.64; p = 0.001). Conclusion: In patients with periodontitis stage II grade A, a single application of PDT using 810-nm laser and ICG provided enhanced benefits compared to SRP alone or SRP+laser in terms of reducing red complex bacterial load and gingival crevicular procalcitonin levels at the 3-month follow-up.
Objective: To analyze the association between sleep duration and periodontal parameters in older adults. Materials and Methods: Data from 1,136 community-resident older adults participating in the Health, Aging, and Body Composition (Health ABC) Study were used. Hours of sleep per night were determined by self-report. Probing pocket depth (PPD) and clinical attachment level (CAL) were evaluated for all teeth present. Periodontal disease was categorized, considering different cut-points of PPD (at least one site with ≥4mm, ≥5mm, or ≥6mm) and CAL (≥3mm in >20%, >30%, or >40% of the sites). Multivariate Poisson regression with robust variance was used to estimate the association of PPD and CAL with sleep duration (>5h/day, >6h/day, and >7h/day). Analyses were adjusted by sociodemographic, behavioral, medical history, and oral health factors. Results: No association was observed between sleep duration and any level of PPD. However, older adults who sleep >7h/day presented a 15% higher prevalence ratio (PR) of presenting CAL ≥3mm in ≥30% of the sites (95% confidence interval [CI]: 1.02–1.29). A similar trend was observed for CAL ≥3mm in ≥40% sites and sleep duration of >7h/day, but did not achieve statistical significance (PR: 1.17; 95% CI: 0.99–1.36). Conclusion: Sleep duration was not consistently associated with periodontal parameters in older adults.
Introduction: Mineralized bovine bone grafts have been widely used as substitutes for bone losses in dental clinics. Studies have shown that exposing the organic components of the bone matrix at surgical sites accelerates bone deposition. Objective: The present study evaluated the bone repair progress of an intraoral bone defect in rats after grafting with mineralized (MBB) and demineralized bovine bone (DBB). Materials and Methods: An intraoral bone defect was created after extraction of the right maxillary first molar, drilling the area of the alveoli of the four distal roots using a diamond tip. The defect was filled with the MBB or DBB graft. Grafting effects were evaluated after 1, 7, 14, 21, and 49 days, using radiographic and histological data. Results: After 14 days, all groups showed full mucosa epithelialization at the surgical site. Radiographic data showed an improvement in bone deposition in defects grafted with the organic matrix. This data was confirmed by histological analysis. A higher level of bone maturation of the neoformed trabeculae and a faster reabsorption rate were also observed to be a feature of the DBB graft. Conclusion: The present in vivo data revealed that the DBB graft may represent an alternative to mineralized biomaterials.
Objective: To evaluate the esthetics of root coverage procedures in patients with bilateral type 1 gingival recessions who were grafted with a subepithelial connective tissue graft (SCTG) and a xenogeneic collagen matrix (XCM). Material and methods: A randomized, double-blind, controlled clinical trial was carried out to compare Pink Esthetic Score (PES) and Root Coverage Esthetic Score (RES). Three examiners evaluated a sequence of 100 photographs of 25 patients with 50 recessions, at baseline and 6 months after surgeries. The test group was treated with coronally-advanced flap (CAF)+XCM, while the control group was treated with CAF+SCTG. Results: The mean values of RES and PES for CAF+XCM were 8.15±0.5 and 8.52±0.51, respectively; and 8.34±1.12 and 8.92±1.33 for CAF+SCTG. The CAF+SCTG group presented more cases that achieved better scores for Gingival Margin Level (GML) (p < 0.001) and Gingival Margin Contour (GMC) (p = 0.024), while CAF+XCM presented more cases with a better soft tissue texture score (STT) (p < 0.001). Thus, both CAF+XCM and CAF+SCTG promoted improvements in general esthetic appearance after 6 months, with no statistical difference. Conclusions: CAF+SCTG and CAF+XCM improved esthetic outcomes, with no difference between PES and RES, after 6 months.
Objective: To develop an application for patients aimed at promoting disease awareness and making evidence-based recommendations to seek professional care or preventive strategies. Materials and Methods: Three expert periodontists identified parameters that, according to the evidence, could represent sociodemographic characteristics, signs, symptoms, or medical conditions that can be important to alert the patient about periodontal health. Each parameter was transformed into a self-questionnaire with a single response, which could be completed using a web application. A focus group was convened with professionals and patients who provided feedback on understanding and relevance and made suggestions for improvement. Results: Several meetings were held to analyze all the possible characteristics/parameters/situations/habits involved in periodontal diseases. The parameters taken into account were bleeding, mobility or loss of teeth due to mobility, gingival recession, visible plaque or calculus, redness or swelling, halitosis, age group to which the patient belongs, frequency of visits to the dentist, diabetes, smoking habit, use of toothpaste, and use of devices for interdental hygiene. To achieve the simplicity of the application, the experts transformed the parameters into 12 questions. Conclusion: The use of this tool in a structured manner helps achieve better patient-professional communication and provides guidance throughout the use of preventive strategies.
Objective: To compare bone level changes and probing depths at the adjacent mandibular second molar (M2) 6 months after impacted mandibular third molar (M3) extraction between patients with and without periodontitis. Material and Methods: Patients referred for extraction of M3 were recruited. Patients were categorized as periodontally susceptible (PSP) or healthy patients (PHP). Six months after surgical extraction of M3 (T1), periodontal probing depths (PPD) and radiographic bone level at M2 were compared between the two groups. Regression analyses were performed to identify factors associated with PPD and bone level changes. Results: Forty-two patients completed the study, and the mean follow-up duration was 6.7 months. There was no significant difference in radiographic bone gain at M2 between PSP and PHP patients (1.26mm vs 1.13 mm). Every 1% increase in full mouth bleeding score at T1 was associated with 2.64mm less bone gain at M2. The PSP group was 6.43 times more likely to have PPD ≥ 5 mm at T1. Conclusions: Second molars in patients with periodontitis were not associated with less bone level gain 6 months after extraction of impacted M3. However, second molars in patients with higher gingival inflammation were associated with less bone gain.
Introduction: Antimicrobial photodynamic therapy (aPDT) is an adjuvant treatment for periodontal disease. Methylene blue (MB) and toluidine blue O (TBO) are commonly used as photosensitizers in aPDT. However, the pH of blue dyes is a rarely discussed topic. Objectives: The aim of this study was to evaluate dentin demineralization and optical properties of acidified (pH1) MB and TBO. A secondary objective of this paper was to discuss the regular pH of blue photosensitizers and their clinical applications. Materials and Methods: Acid TBO and MB (pH1) were compared to conventional dyes and/or treatments. Dentin demineralization was measured by profilometry and microhardness test. Optical properties were evaluated by absorbance measurements and photodegradation rate. Statistical analyses were performed with Kruskal-Wallis test (p<0.05). Results: Acid TBO promoted dentin demineralization like positive control (citric acid/tetracycline) (p>0.05). Acidification of MB and TBO promoted no photodegradation and change of absorption band, respectively. Acid MB and TBO promoted similar demineralization of dentin surfaces as citric acid/tetracycline. Conclusion: Acidification impaired a photodynamic reaction, impeding the use of acidified photosensitizers in aPDT procedures.
This article describes the removal of a malpositioned dental implant, using an implant retriever, followed by guided tissue regeneration with the use of an xenogeneic graft and a dense polytetrafluorethylene membrane that remained partially exposed for 28 days, and the post-surgical prosthetic and orthodontic treatment until conclusion of the oral rehabilitation procedure. The patient, 50 years of age, presented to a private clinic for evaluation of an implant supported fixed crown, with unsatisfactory esthetic appearance and function. The treatment plan involved the removal of this implant, guided bone regeneration, and placement of a new implant in a better 3D position. Subsequently, the patient received a provisional dental prosthesis, orthodontic treatment in order to realign the gingival margins, and additional rehabilitation with the application of some ceramic veneers to enhance the patient's esthetic appearance, improve function, and show the 1-year follow-up of the case. The treatment plan was shown to be appropriate for this case, in which soft and hard tissue were adequately regenerated, and resulted in good oral rehabilitation with tissue stability around the teeth and implant.
