Abstract The high concentration of glucose in the blood in Type 2 diabetes (T2D) may be related to either insulin resistance or insulin deficiency. Moreover, the literature points to periodontitis as the main oral disease caused by glycemia imbalance. The quantification of inflammatory markers in blood or saliva samples of T2D patients may represent a valuable tool in revealing how well an individual’s immune system can respond to injuries and periodontal treatment. In addition, an evaluation of the cytokine expression is extremely relevant to help understand the connection between periodontitis and T2D. This systematic review and meta-analysis aimed to evaluate the expression of inflammatory markers in T2D patients with periodontitis, compared with non-diabetic patients with periodontitis. A total of 3,894 studies were retrieved after a systematic literature search, 15 of which were included in the systematic review, and 4 of these 15, in the meta-analysis. The results did not indicate any statistical difference between the groups regarding TNF-α and IL-6 markers. T2D patients with periodontitis had increased levels of IL-10, compared with non-diabetic individuals with periodontitis (p = 0.003). On the other hand, the IL-4 concentration in non-diabetic individuals with periodontitis was high, compared with the T2D group (p< 0.001). Several studies did not include quantitative results and were excluded from the meta-analysis. The high IL-10 expression and low IL-4 expression in the T2D group suggest an association between the level of these markers and the impairment of the immune response in T2D patients with periodontitis.

Objetivo: Investigar os efeitos da terapia periodontal não cirúrgica sobre níveis de proteína C-reativa ultrassensível no soro e associação dessa com o índice de massa corporal e lipoproteína de alta densidade em indivíduos com periodontite grave. Métodos: O soro de 28 indivíduos (idade média: 34,36±6,24; 32% homens) com periodontite grave e 27 controles saudáveis (idade média: 33,18±6,42; 33% homens) foi coletado antes da terapia periodontal. Novas amostras de sangue foram obtidas dos 23 indivíduos que completaram o tratamento periodontal (entre 9-12 meses após). Parâmetros bucais e sistêmicos, tais como contagem do número de células do sangue, exame complementar de glicose, lipidograma e níveis de proteína C-reativa ultrassensível, acessados pelo método de nefelometria (imunonefelometria ultrassensível) foram incluídos. Resultados: Antes da terapia, a proporção de indivíduos com proteína C-reativa ultrassensível <0,3 mg/dL no grupo periodontite foi estatisticamente menor que a proporção de indivíduos com proteína C-reativa ultrassensível <0,3 mg/ dL nos controles (P<0,0216). Após a terapia, a proporção de indivíduos com proteína C-reativa ultrassensível <0,3 mg/dL foi estatisticamente maior (65,22%) (P<0,0339). O valor médio para índice de massa corporal foi estatisticamente menor nos indivíduos com proteína C-reativa ultrassensível <0,3 mg/dL (24,63±4,19), comparados àqueles com proteína C-reativa ultrassensível ≥0,3 mg/dL (28,91±6,03) (P<0,0411). O colesterol lipoproteína de alta densidade pós-terapia apresentou valor médio estatisticamente maior (P<0,0027). Conclusão: Em indivíduos com periodontite e saudáveis sistemicamente, a terapia periodontal foi associada com o decréscimo dos níveis de proteína C-reativa ultrassensível circulante no soro e aumento de lipoproteína de alta densidade. O ensaio clínico foi registrado no http://www.clinicaltrials.gov.br/, No. RBR-24T799.

Objective: To investigate the effects of nonsurgical periodontal therapy on levels of high-sensitivity C-reactive protein in the sera and its association with body mass index and high density lipoprotein in subjects with severe periodontitis. Methods: Sera from 28 subjects (mean age: 34.36±6.24; 32% men) with severe periodontitis and 27 healthy controls (mean age: 33.18±6.42; 33% men) were collected prior to periodontal therapy. Blood samples were obtained from 23 subjects who completed therapy (9-12 months). Oral and systemic parameters such as the number of blood cells, glucose examination, lipid profile, and high-sensitivity C-reactive protein levels accessed by high-sensitivity immunonephelometry assay, were included. Results: Before therapy, in the periodontitis group, the ratio of subjects with high-sensitivity C-reactive protein <0.3 mg/dL was statistically lower than in the control group (P<0.0216). After therapy, the ratio of subjects with high-sensitivity C-reactive protein <0.3 mg/dL was significantly higher (65.22%) (P<0.0339). The mean value for body mass index was statistically lower in subjects with high-sensitivity C-reactive protein <0.3 mg/dL (24.63±4.19), compared with those with high-sensitivity C-reactive protein >0.3 mg/dL (28.91±6.03) (P<0.0411). High density lipoprotein presented a mean value statistically higher after therapy (P<0.0027). Conclusion: In systemically healthy subjects with periodontitis, periodontal therapy was associated with decreased levels of circulating high-sensitivity C-reactive protein and increase of high density lipoprotein in serum. The clinical trial was registered at http://www.clinicaltrials.gov.br/, No. RBR-24T799.

Phagocytosis by neutrophils and monocytes constitutes the main defense mechanism against bacterial challenges in periodontitis. Phagocytosis by neutrophils has already been evaluated, whereas phagocytic function of monocytes has hardly been addressed so far. Objectives: The aim of this study was to assess phagocytosis by neutrophils and monocytes in periodontitis. Material and Methods: The sample included 30 subjects with severe periodontitis and 27 control subjects without periodontal disease. The phagocytic index (PhI) was calculated as the mean number of adhered/ingested Saccharomyces cerevisiae per phagocytozing monocyte or neutrophil multiplied by the percentage of phagocytes involved in phagocytosis. Results: A significant reduction in phagocyte functions was observed in individuals with periodontitis. The median of PhI of neutrophils using nonsensitized S. cerevisiae was 3 for the control group, and 1.5 for the periodontitis group (p=0.01, Mann-Whitney test). The median of PhI of monocytes with non-sensitized S. cerevisiae was 26.13 for the control group, and 13.23 for the periodontitis group (p=0.03, Mann Whitney test). The median of PhI of monocytes assessed with sensitized S. cerevisiae was 97.92 for the control group and 60.1 for the periodontitis group (p=0.005, t-test). Conclusion: The data demonstrated a reduction in the function of phagocytes, suggesting a decrease in immune defenses in periodontitis.

OBJECTIVES: This study assessed the bone density gain and its relationship with the periodontal clinical parameters in a case series of a regenerative therapy procedure. MATERIAL AND METHODS: Using a split-mouth study design, 10 pairs of infrabony defects from 15 patients were treated with a pool of bovine bone morphogenetic proteins associated with collagen membrane (test sites) or collagen membrane only (control sites). The periodontal healing was clinically and radiographically monitored for six months. Standardized pre-surgical and 6-month postoperative radiographs were digitized for digital subtraction analysis, which showed relative bone density gain in both groups of 0.034 ± 0.423 and 0.105 ± 0.423 in the test and control group, respectively (p>0.05). RESULTS: As regards the area size of bone density change, the influence of the therapy was detected in 2.5 mm² in the test group and 2 mm² in the control group (p>0.05). Additionally, no correlation was observed between the favorable clinical results and the bone density gain measured by digital subtraction radiography (p>0.05). CONCLUSIONS: The findings of this study suggest that the clinical benefit of the regenerative therapy observed did not come with significant bone density gains. Long-term evaluation may lead to a different conclusions.

Os trabalhos realizados no Brasil a respeito das principais afecções bucais dos gerontes mostram situação preocupante. O objetivo deste estudo foi estimar a frequência de edentulismo, analisar o uso e a necessidade de prótese, calcular o índice CPOD e verificar a condição periodontal de idosas residentes no Distrito Federal. Cento e quarenta mulheres com idade igual ou superior a sessenta anos foram examinadas. A condição de cada prótese foi avaliada observando presença de prejuízo estético ou funcional. Em seguida, foi realizado exame clínico para detectar a presença de cárie, restaurações e dentes perdidos para cálculo do índice CPOD. O exame periodontal incluiu a verificação do índice de placa visível, índice de sangramento gengival, medidas de profundidade de sondagem clínica, perda de inserção clínica e mobilidade dental de todos os dentes presentes. Os resultados revelaram péssimas condições bucais dos pacientes examinados. A taxa de edentulismo mostrou-se elevada, o índice CPOD foi alto (29,8), com predomínio do componente extraído (87,1%) e a condição periodontal foi considerada grave. A partir destes dados, pode-se concluir que o perfil da condição bucal das idosas representadas neste estudo é precário, o que reflete a necessidade de se elaborar programas de promoção de saúde e de reabilitação para este segmento da população.

Data from Brazilian researches that evaluated oral health of elderly people show a worrisome situation. The purpose of this study was to estimate the frequency of edentulism, analyze both the use and need profiles of prosthesis, calculate the DMFT index and check the condition of periodontal elderly residents in the Federal District. One hundred and forty women aged 60 years or above were examined. The condition of each prosthesis was evaluated to detect the presence of functional or aesthetic damage. Then, clinical examination was carried out to detect the number of decayed, missing or filled teeth in order to calculate the DMFT index. The periodontal examination included the index of visible plaque, bleeding index, measurement of clinical probing depth, measurement of clinical attachment level and teeth mobility. The results showed poor oral conditions of the patients. The rate of edentulism was high, the DMFT index was elevated (29.8) with a predominance of the extracted component (87.1%) and periodontal condition was considered severe. From these data we can conclude that the oral condition of elderly represented in this study is precarious and reflects the need for health promotion and rehabilitation programs for this segment of the population.

Os trabalhos realizados no Brasil a respeito das principais afecções bucais dos gerontes mostram situação preocupante. O objetivo deste estudo foi estimar a frequência de edentulismo, analisar o uso e a necessidade de prótese, calcular o índice CPOD e verificar a condição periodontal de idosas residentes no Distrito Federal. Cento e quarenta mulheres com idade igual ou superior a sessenta anos foram examinadas. A condição de cada prótese foi avaliada observando presença de prejuízo estético ou funcional. Em seguida, foi realizado exame clínico para detectar a presença de cárie, restaurações e dentes perdidos para cálculo do índice CPOD. O exame periodontal incluiu a verificação do índice de placa visível, índice de sangramento gengival, medidas de profundidade de sondagem clínica, perda de inserção clínica e mobilidade dental de todos os dentes presentes. Os resultados revelaram péssimas condições bucais dos pacientes examinados. A taxa de edentulismo mostrou-se elevada, o índice CPOD foi alto (29,8), com predomínio do componente extraído (87,1%) e a condição periodontal foi considerada grave. A partir destes dados, pode-se concluir que o perfil da condição bucal das idosas representadas neste estudo é precário, o que reflete a necessidade de se elaborar programas de promoção de saúde e de reabilitação para este segmento da população.

Data from Brazilian researches that evaluated oral health of elderly people show a worrisome situation. The purpose of this study was to estimate the frequency of edentulism, analyze both the use and need profiles of prosthesis, calculate the DMFT index and check the condition of periodontal elderly residents in the Federal District. One hundred and forty women aged 60 years or above were examined. The condition of each prosthesis was evaluated to detect the presence of functional or aesthetic damage. Then, clinical examination was carried out to detect the number of decayed, missing or filled teeth in order to calculate the DMFT index. The periodontal examination included the index of visible plaque, bleeding index, measurement of clinical probing depth, measurement of clinical attachment level and teeth mobility. The results showed poor oral conditions of the patients. The rate of edentulism was high, the DMFT index was elevated (29.8) with a predominance of the extracted component (87.1%) and periodontal condition was considered severe. From these data we can conclude that the oral condition of elderly represented in this study is precarious and reflects the need for health promotion and rehabilitation programs for this segment of the population.

OBJECTIVES: The aim of this study was to analyze the periodontal parameters of patients with chronic renal failure. MATERIAL AND METHODS: The periodontal status of 16 Brazilian patients aged 29 to 53 (41.7±7.2) years with chronic renal failure (CRF) and another matched group of 14 healthy controls with periodontitis was assessed clinically and microbiologically. Probing pocket depth (PPD), gingival recession (GR), dental plaque index (PLI), gingival index (GI), and dental calculus index (CI) were the clinical parameters recorded for the entire dentition (at least 19 teeth), while the anaerobic periodontopathogen colonization in four sites with the highest PPD was evaluated using the BANA test ("PerioScan"; Oral B). RESULTS: The results for the CRF group and control group, respectively were: PPD: 1.77±0.32 and 2.65±0.53; GR: 0.58±0.56 and 0.51±0.36; PLI: 1.64±0.56 and 1.24±0.67; GI: 0.64±0.42 and 0.93±0.50; CI: 1.17±0.54 and 0.87±0.52. Comparison between groups using the "t" test revealed a significantly increased PPD (p<0.001) in the control group. Comparison of the other clincial parameters by the Mann-Whitney test showed differences only for PLI, which was significantly higher (p<0.05) in the CRF group. Spearman's test applied to each group showed a positive correlation among all clinical parameters, except for GR (p<0.05). None of the groups showed any correlation between GR and GI, while a significant negative correlation between GR and PPD was observed for the CRF group. The percentage of BANA-positive sites was 35.9% for the CRF group and 35.7% for the control group. The BANA test correlated positively with PPD only in the control group and with GR only in the CRF group. CONCLUSIONS: In spite of a higher PLI and dense anaerobic microbial population even in shallow PPD, patients with CRF exhibited better periodontal conditions than periodontitis patients, which is an evidence of altered response to local irritants.

OBJECTIVES: The purpose of this study was to evaluate the prevalence of alveolar bone loss (BL) in healthy children treated at private pediatric dentistry clinics in Brasília, Brazil. MATERIAL AND METHODS: The research included 7,436 sites present in 885 radiographs from 450 children. The BL prevalence was estimated by measuring the distance from the cementoenamel junction (CEJ) to alveolar bone crest (ABC). Data were divided in groups: (I) No BL: distance from CEJ to ABC is <2 mm; (II) questionable BL (QBL): distance from CEJ to ABC is >2 and <3 mm; (III) definite BL (DBL): distance from CEJ to ABC >3 mm. Data were treated by the chi-square nonparametric test and Fisher's exact test (p<0.05). RESULTS: Among males, 89.31% were classified in group I, 9.82% were classified in group II and 0.85% in group III. Among females, 93.05%, 6.48% and 0.46% patients were classified in Group I, II and III, respectively. The differences between genders were not statistically significant (Chi-square test, p = 0.375). Group composition according to patients' age showed that 91.11% of individuals were classified as group I, 8.22% in group II and 0.67% in group III. The differences among the age ranges were not statistically significant (Chi-square test, p = 0.418). The mesial and distal sites showed a higher prevalence of BL in the jaw, QBL (89.80%) and DBL (79.40%), and no significant difference was observed in the distribution of QBL (Fisher's exact test p = 0.311) and DBL (Fisher's exact test p = 0.672) in the dental arches. The distal sites exhibited higher prevalence of both QBL (77.56%) and DBL (58.82%). CONCLUSIONS: The periodontal status of children should never be underestimated because BL occurs even in healthy populations, although in a lower frequency.

Este estudo teve como objetivo avaliar a aplicação do ''pool'' de BMPs bovinas no tratamento de defeitos intra-ósseos. A amostra constou de quinze indivíduos com idade entre 26 e 57 anos, apresentando um par de defeitos intra-ósseos comparáveis, localizados no mesmo arco em dentes do mesmo tipo (pré-molares ou molares) e com perda de inserção (PI) ³5mm. Em cada indivíduo, o defeito teste foi tratado com a associação ''pool'' de BMPs- carreador Hidroxiapatita reabsorvível (BMPs-HA), matriz orgânica bovina desmineralizada liofilizada (MO) e barreira de colágeno bovino, enquanto os defeitos controle foram tratados com MO-HA e barreira de colágeno. Na avaliação clínica aos seis meses após a medida inicial, o grupo teste apresentou variação de profundidade de sondagem (PS) de -1,63mm ± 1,141 na vestibular (V) e -1,93mm ± 0,961 na lingual (L) e variação do nível de inserção (NI) de -1,60mm ± 1,168 na V e -1,46mm ± 0,972 na L. O grupo controle apresentou variação de PS de -1,93mm ± 1,347 (V) e -2,0mm ± 1,511 (L) e variação de NI de -1,03mm ± 1,245 (V) e -1,30mm ± 1,114 (L). A análise de variância indicou que a variação de PS e NI foi significativa em ambos os grupos (p<0,05). Entretanto, de acordo com o teste t não houve diferença significativa entre os grupos quanto à variação PS e NI (p<0,05). Em conclusão, a aplicação do ''pool'' de BMPs não oferece benefícios adicionais ao tratamento de defeitos intra-ósseos.

The purpose of this study was to evaluate the effect of the pool of bovine BMPs on the treatment of intrabony defects. The sample comprised 15 patients aged 26 to 57 years old presenting with 10 pairs of lesions of 2 or 3 walls or 2-3 walls ³5mm, located in the same type teeth (premolar or molar) and same jaw. The test defects were treated with combination of a pool of bovine bone morphogenetic and resorbable hydroxyapatite carrier (BMPs- HA), bovine demineralized bone matrix (MB) and coverage by a bovine collagen barrier membrane. The control defects were treated with MB-HA and covered by a bovine collagen membrane. The clinical measurements at six months after therapy in the test group revealed a reduction in the mean probing pocket depth (PPD) of 1.63 ± 1.41mm (B) and 1.93 ± 0.96mm (L) and a mean change in the clinical attachment level (CAL) of 1.60 ± 1.16mm (B) and 1.46 ± 0.97mm (L). The control group showed a mean reduction of PPD of 1.93 ± 1.34mm (B) and 2.0 ± 1.51mm (L) and a mean change of CAL of 1.03 ± 1.24mm (B) and 1.30 ± 1.14 mm (L). The analysis of variance (ANOVA) demonstrated that the changes in the clinical parameters were statistically significant (p<0.05). There were no significant differences between the test and controls subjects (Student's test, p<0.005). These findings suggest that the use of a pool of bovine BMPs do not provide added effects to GTR in the treatment of intrabony defects.