Abstract Periodontitis Stage III-IV, Grade C (PerioC) is a severe form of Periodontitis. The individual genetic background has been shown to be an important etiopathogenic factor for the development of this disease in young, systemically healthy, and non-smokers patients. Recently, after exome sequencing of families with a history of the disease, PerioC was associated with three single nucleotide variations (SNVs) – rs142548867 (EEFSEC), rs574301770 (ZNF136), and rs72821893 (KRT25) – which were classified as deleterious or possibly harmful by prediction algorithms. Objective Seeking to validate these findings in a cohort evaluation, this study aims to characterize the allele and genotypic frequency of the SNVs rs142548867, rs574301770, and rs72821893 in the Brazilian population with PerioC and who were periodontally healthy (PH). Methodology Thus, epithelial oral cells from 200 PerioC and 196 PH patients were harvested at three distinct centers at the Brazilian Southern region, their DNA were extracted, and the SNVs rs142548867, rs574301770, rs72821893 were genotyped using 5′-nuclease allelic discrimination assay. Differences in allele and genotype frequencies were analyzed using Fisher’s Exact Test. Only the SNV rs142548867 (C > T) was associated with PerioC. Results The CT genotype was detected more frequently in patients with PerioC when compared with PH subjects (6% and 0.5% respectively), being significantly associated with PerioC (odds ratio 11.76, p=0.02). Conclusion rs142548867 represents a potential risk for the occurrence of this disease in the Brazilian population.

Abstract The presence of a tooth-surface defect, such as a non-carious cervical lesion (NCCL), associated with sites of gingival recession (GR) defects creates a combined soft tissue/tooth defect (CD) that requires a different treatment plan. This study aimed to critically review the literature regarding the available treatment protocols for CDs and suggest a new decision-making process. NCCLs were classified as Class A-: the cementoenamel junction (CEJ) was visible and the root surface discrepancy was < 0.5 mm (no step); Class A+: CEJ was visible and the root surface discrepancy was > 0.5 mm (with a step); Class B-: unidentifiable CEJ without a step; Class B+: unidentifiable CEJ with a step. NCCLs affecting both root and crown surfaces (Class B) lead to CEJ destruction and consequently eliminate an important landmark used before and after root coverage procedures. The depth of the root surface discrepancy is vital owing to its possible impact on soft tissue adaptation after healing, which, in turn, may influence the treatment options, namely the use of graft and/or composites to compensate for the discrepancy. Clinically, a step with horizontal depth greater than 0.5 mm should be recognized as the minimum threshold value to define this condition. Extremely deep defects tend to assume a V-shaped topography. Therefore, extremely deep V-shaped defects were classified into subclasses A+V, a V-shaped defect, and B+V, a V-shaped defect with loss of CEJ, for management considerations. The treatment options, supported by the literature, and a decision-making process to deal with each condition are presented.

Abstract Although dental implants and bone regenerative procedures are important approaches for the reestablishment of esthetics and function in young patients with a history of generalized aggressive periodontitis (GAP), no predictable outcomes have been reported, and the host osteo-immunoinflammatory response may play a relevant role in this context. In view of the lack of molecular investigations into the bone tissue condition of young patients with periodontitis, the aim of this study was to evaluate the gene expression of bone-related factors in this population. Bone biopsies were obtained from the posterior mandible in 16 individuals previously diagnosed with GAP and on periodontal support therapy and from 17 periodontally healthy (PH) patients. The gene expression of tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-β, receptor activator of the NF-κB ligand (RANKL), osteoprotegerin (OPG), osteocalcin (OC), bone sialoprotein (BSP), and type I collagen (COL-I), important biomarkers of bone turnover, was evaluated by qRT-PCR. Lower TGF-β and OPG mRNA levels were observed in GAP patients compared to PH individuals (p ≤ 0.05). There were no between-group differences in levels of TNF-α, BSP, RANKL, OC, or COL-I mRNA (p>0.05). In young adults, a history of periodontal disease can negatively modulate the gene expression of important bone-related factors in alveolar bone tissue. These molecular outcomes may contribute to the future development of therapeutic approaches to benefit bone healing in young patients with history of periodontitis via modulation of osteo-immuno-inflammatory biomarkers.

Resumo O presente estudo teve como objetivo avaliar os efeitos clínicos e microbiológicos de terapia periodontal cirúrgica e não cirúrgica no tratamento da periodontite agressiva generalizada (PAgG). Dezesseis pacientes portadores de PAgG foram incluídos neste estudo clínico, prospectivo, randomizado, de boca dividida. Os quadrantes superiores de cada paciente foram alocados em dois grupos: um grupo de terapia não-cirúrgica (NST) e um grupo de terapia cirúrgica (ST). Os parâmetros clínicos avaliados foram: índice de placa (PI), sangramento à sondagem índice (BoP), profundidade de sondagem (PD), nível clínico de inserção (CAL) e posição da margem gengival (GMP). Também foram determinadas as concentrações de Porphyromonas gingivalis (Pg) e Aggregatibacter actinomycetemcomitans (Aa) no biofilme subgengival. Os parâmetros clínicos e microbiológicos foram avaliados no início, 3, 6 e 12 meses após o tratamento. A terapia cirúrgica foi capaz de promover maior redução de PD em comparação com NST em bolsas profundas aos 12 meses (p<0,05) e em dentes posteriores aos 6 meses (p<0,05). Além disso, houve maior recessão gengival nos dentes posteriores do grupo ST no 6° mês (p<0,05). Entretanto, ST não promoveu ganho adicionais de inserção (CAL) em nenhum período do avaliação. A avaliação microbiológica não mostrou diferença estatística nos níveis de Aa e Pg, para ambos os grupos, em todos os períodos de acompanhamento. O tratamento cirúrgico promoveu benefícios clínicos similares ao tratamento não cirúrgico em pacientes com PAgG. Além disso, ambas as terapias não conseguiram reduzir os níveis Aa e Pg após terapia.

Abstract The present study aimed to evaluate clinical and microbiological effects of surgical and nonsurgical periodontal therapy in generalized aggressive periodontitis (GAgP) treatment. Sixteen GAgP patients were included in this randomized split-mouth design clinical trial. Maxillary quadrants were allocated into two groups: Nonsurgical Therapy (NST) and Surgical Therapy (ST). The following clinical parameters were assessed: plaque index (PI), bleeding on probing index (BoP), probing depth (PD), clinical attachment level (CAL) and gingival margin position (GMP). Concentrations of Porphyromonas gingivalis (Pg) and Aggregatibacter actinomycetemcomitans (Aa) in the subgingival biofilm were also determined. Clinical and microbiological parameters were assessed at baseline (n=16), 3 (n=15), 6 (n=15) and 12 months (n=8) after treatment. ST was able to promote higher PD reduction compared to NST in deep pockets at 12 months (p<0.05) and in posterior teeth at 6 months (p<0.05). In addition, higher gingival recession was observed in posterior teeth of the ST group at the 6th month (p<0.05). However, ST failed to promoted additional CAL gain in any timepoint (p>0.05). Moreover, microbiological evaluation showed no statistical difference in levels of Aa and Pg for both groups at all follow-up periods. Surgical therapy promoted similar clinical benefits to GAgP therapy. Moreover, both therapies failed to reduce Aa and Pg levels at different follow-up times.

Resumo Este estudo avaliou o efeito preventivo e pós-operatório de dexametasona e ibuprofeno na prevenção da dor, desconforto, edema e interferência na vida diária, em pacientes submetidos ao recobrimento radicular associado a enxerto de tecido conjuntivo subepitelial (CAF + CTG). Vinte pacientes foram divididos aleatoriamente: Grupo AINES: Ibuprofeno 400 mg 60 min antes da cirurgia + Ibuprofeno 400 mg no período pós-operatório e Grupo AIES: 4 mg de dexametasona 60 min antes da cirurgia + Dexametasona 4mg no pós-operatório. A medicação pós-operatória foi administrada 8 e 16 horas pós-cirurgia. Cada paciente recebeu questionários com base na escala numérica NRS-101 (101 pontos numéricos) e perguntas de múltipla escolha (VRS-4) sobre dor / desconforto no período transoperatório, de hora em hora durante 8 h e uma vez por dia durante três dias após a cirurgia. A Escala Visual Analógica (VAS) para análise de edema e interferência na vida diária também foi respondida no 1º, 2º, 3º e 7º dia após a cirurgia. O grau de ansiedade foi estatisticamente avaliado pelo teste do Qui-quadrado. Mann-Whitney e Friedman foram utilizados para os demais questionários. Para o tempo de cirurgia e o número de analgésicos consumidos, o teste t de Student foi aplicado. Os pacientes que utilizaram dexametasona apresentaram uma tendência para menores níveis de dor quando comparados aos indivíduos que ingeriram ibuprofeno, com diferença significativa observada 3 h após o procedimento cirúrgico (p<0,05). A utilização de dexametasona também promoveu menores níveis de edema até ao segundo dia e menor interferência na vida diária no terceiro dia, quando comparada com o ibuprofeno (p<0,05). Concluiu-se que a utilização de dexametasona como medicamento preventivo e pós-operatório mostra ser mais adequado como protocolo medicamentosos para cirurgias de recobrimento radicular com associação de enxerto de tecido conjuntivo.

Abstract This trial evaluated the preemptive and postoperative effect of dexamethasone and ibuprofen on prevention of pain/discomfort, edema and interference in daily life in patients undergoing root coverage combined with subepithelial connective tissue graft (CAF + CTG). Twenty patients were randomly assigned as follows: NSAID Group: 400mg Ibuprofen 60 min preemptive + 400mg Ibuprofen postoperative; or SAID Group: 4mg Dexamethasone 60 min preemptive + 4mg Dexamethasone postoperative. The postoperative medication was administered 8 and 16 h post-surgery. Each patient received questionnaires based on a numeric scale (101-point numeric scale rate [NRS-101]) and multiple choice questions (four-point verbal rating scale [VRS-4]) about trans-operative pain/discomfort, hourly for 8 h after surgery and once a day for three days. A Visual Analogue Scale (VAS) for edema and interference in daily life during the 1st, 2nd, 3rd and 7th day was also answered. The degree of anxiety was rated statistically by the Chi-square test. The Mann-Whitney and Friedman tests were used for the other questionnaires. The surgery time and number of analgesic pills consumed were compared using Student’s t-test. Patients who used dexamethasone presented a trend toward less pain when compared to individuals who ingested ibuprofen, with a significant difference observed 3 h after the procedure (p<0.05). The use of dexamethasone also promoted less edema until the 2nd day and lower interference in daily life on the third day when compared with ibuprofen (p<0.05). We concluded that the use of dexamethasone as a preemptive and postoperative medication was more suitable as a drug therapeutic protocol for CAF + CTG.

AIM: To investigate the indication of systemic antimicrobial agents used by dental professionals for treatment of patients affected by periodontal diseases. METHODS: Interviews by a questionnaire were held with 225 professionals of different dental specialties and who performed periodontal treatment. RESULTS: Among interviewees, 94% indicated systemic antibiotics as a form of periodontal disease treatment. Their main indication was for periodontal abscesses (80%) followed by aggressive periodontitis (62%) and necrotizing diseases (45%). The most frequently used antibiotics were amoxicillin (81%) and metronidazole (57%). The medications were indicated in association with mechanical therapy by 67% of the professionals. As regards the occasion of indication, 60% indicated systemic antibiotic therapy before and after mechanical periodontal scaling and root planing. Seventy-eight percent of the professionals indicated antibiotics associated with periodontal surgery for access to scaling, and 76% indicated it before and after the surgical procedure. Among the interviewees, 99% took into account systemic involvement for drug administration. CONCLUSIONS: It was concluded that a considerable portion of professionals indicate systemic antibiotic-therapy in an incoherent manner and in situations in which there is no indication for antibiotic use, or with ineffective protocols.

The aim of the present study was to evaluate the frequency of detection of Mogibacterium timidum in subgingival samples of subjects with generalized aggressive periodontitis (GAgP) and uncontrolled diabetic and non-diabetic subjects with generalized chronic periodontitis (GChP). 48 patients with GAgP, 50 non-diabetic and 39 uncontrolled (glycated hemoglobin >7%) type 2 diabetic subjects with GChP were enrolled in this study. Subgingival biofilm were collected from deep pockets (probing depth > 7 mm). After DNA extraction, M. timidum was detected by Nested Polymerase Chain Reaction and chi-square test was used to data analysis (p>0.05). There were no differences in the frequency of detection of M. timidum between subjects with GAgP (35%) and non-diabetic subjects with GChP (40%) (p>0.05). The frequency of detection of M. timidum was significantly higher in deep pockets of diabetic subjects with GChP (56%) when compared to GAgP (p<0.05), but similar to non-diabetic subjects with GChP (p>0.05). The frequency of detection of M. timidum was higher in subjects GChP presenting uncontrolled type 2 diabetes mellitus, when compared to GAgP subjects.

O objetivo deste estudo foi avaliar o defeito na superfície radicular produzido por curetas manuais e instrumento ultra-sônico em diferentes potências. Quarenta superfícies radiculares foram divididas de acordo com o tratamento em 4 grupos: a) Curetas Gracey; b) Instrumento ultra-sônico a 10%; c) Instrumento ultra-sônico a 50%; d) Instrumento ultra-sônico a 100%. Cada amostra recebeu 15 movimentos de raspagem e foram divididas ao meio para avaliar: (1) a profundidade do defeito produzido pela instrumentação e (2) a área de contato do instrumento com a superfície. Todas as superfícies foram então avaliadas com o uso de Microscopia Eletrônica de Varredura. Para a análise estatística foi utilizado o teste Tukey/ANOVA. Os resultados (média ± DP) encontrados para a área de contato foram significantemente maiores para a instrumentação manual (2092,9 ± 482,0) que para os instrumentos ultra-sônicos, independentemente da potência utilizada (606,8 ± 283,0; 858,6 ± 422,5; 1212,0 ± 366,7, respectivamente). Os valores para a profundidade do defeito demonstraram numericamente, mas não estatisticamente, diferenças entre a instrumentação manual (66,1 ± 34,0) e ultra-sônica em 10%, 50% ou 100% de potência (52,4 ± 22,1; 72,0 ± 29,9; 77,7 ± 37,7, respectivamente). Os resultados encontrados demonstraram que a instrumentação ultra-sônica produziu defeitos com profundidade similar aos produzidos pela instrumentação manual, com um menor contato do instrumento, independente da potência utilizada.

The aim of this study was to evaluate the root surface defect produced by hand curettes and ultrasonic tips with different power settings. Forty root surfaces were divided into 4 groups according the treatment: Gracey curettes, ultrasonic scaler at 10% power, ultrasonic scaler at 50% power and ultrasonic scaler at 100% power. Each specimen was instrumented with 15 strokes and the and divided in the middle to evaluate: (1) the defect depth produced by the instrumentation and (2) contact area of the instrument tips, which was analyzed by scanning electron microscopy. ANOVA and Tukey's test were used for statistical analysis (a=0.05). The results (mean ± SD) of the contact area showed significantly greater defects (p<0.05) for the hand instrumented groups (2092.9 ± 482) compared to the ultrasonic groups (606.8 ± 283.0; 858.6 ± 422.5; 1212.0 ± 366.7, respectively), independently of the power setting. The values for the defect depth on root surface showed no statistically significant difference (p<0.05) between hand instrumentation (66.1 ± 34.0) and ultrasonic scaling at 10%, 50% or 100% power settings (52.4 ± 22.1; 72.0 ± 29.9; 77.7 ± 37.7, respectively). The findings of this study demonstrate that ultrasonic instrumentation produced a similar defect depth to that of hand instrumentation, with a smaller tip contact area, independently of the power setting used for scaling.