RESUMO Objetivo: Avaliar clinicamente o efeito do debridamento ultrassônico de boca toda no tratamento da periodontite crônica severa em pacientes diabéticos. Métodos: Dezesseis pacientes diabéticos descompensados (Hemoglobina Glicada ≥ 7%) com periodontite crônica severa (mínimo de 8 dentes com profundidade de sondagem ≥ 5 mm e sangramento à sondagem) separados aleatoriamente em 2 grupos: Controle (7): raspagem e alisamento radicular por quadrante e Teste (9): debridamento ultrassônico sessão única de 45 minutos. Os parâmetros clínicos avaliados foram: Índice de placa, Índice gengival, Sangramento à Sondagem, Profundidade de Sondagem, Nível de inserção clínico e Posição da Margem Gengival. As variáveis foram avaliadas no início, 1 e 3 meses após o tratamento. Para análise das variáveis quantitativas (Profundidade de sondagem, Nível de inserção e Posição da margem gengival de bolsas moderadas) foram realizados ANOVA e teste de Tukey e para as demais foram utilizados os testes de Friedman e Mann-Whitney. Resultados: Observou-se melhora na profundidade de sondagem e nível de inserção clínica após o tratamento em ambos os grupos, sem diferenças estatisticamente significativas entre eles. Após 3 meses, nas bolsas inicialmente profundas, a profundidade de sondagem reduziu 1,6 e 1,7 mm nos grupos teste e controle, respectivamente. Houve um ganho estatisticamente significante no nível de inserção ≥ 2 mm nos grupos controle (10,1%) e teste (13,4%), aos 3 meses. Conclusão: O debridamento ultrassônico de boca toda promoveu resultados clínicos semelhantes aos obtidos com a raspagem e alisamento radicular no tratamento da periodontite crônica severa em indivíduos diabéticos.

ABSTRACT Objective: The purpose of this study was to clinically evaluate the effect of one-stage full-mouth ultrasonic debridement in the treatment of diabetic subjects with severe chronic periodontitis. Methods: Sixteen patients with uncontrolled diabetes (glycated hemoglobin ≥ 7%) and severe chronic periodontitis (at least 8 teeth with a probing depth and bleeding on probing were selected and randomly assigned to 2 treatment groups: control group (n=7) - quadrant-wise scaling and root planning; test group (n=9) - full-mouth ultrasonic debridement in one session of 45 minutes. The following outcomes were assessed: plaque index, gingival index, bleeding on probing, probing depth, clinical attachment level and gingival margin position. All parameters were assessed at baseline, 1 and 3 months after treatment. Probing depth, clinical attachment level and gingival margin position were analyzed using ANOVA and Tukey test, and the other clinical parameters analysed with the Friedman and Mann-Whitney tests. Results: An improvement in probing depth, clinical attachment level was observed after treatment in both groups, but without statistically significant differences between them. After 3 months, in initially deep pockets, the PD decreased 1.6 mm and 1.7 mm in test and control group, respectively. Clinical attachment level gain ≥ 2 mm was statistically significant at sites in control (10.1%) and test (13,4%) groups in 3 months. Conclusions: One-stage full-mouth ultrasonic debridement promoted similar clinical outcomes to those obtained with the scaling and root planning in the treatment of diabetic subjects with severe chronic periodontitis.

This paper analyses how buyer companies perceive the value added to products and services offered by their suppliers and identifies the predominant elements that affect purchasing decisions and establishment of relationships between companies in a B2B context. A multiple case study was developed in 12 buyer companies from three industrial segments in southern Brazil: metal-mechanics, furniture and foods. The findings show that for supplier companies in the metal-mechanics industry to add value, they must identify buyers' needs, develop technology/innovation, be focused on competitive aspects, keep control of the supply chain, provide different purchasing channels, develop partnerships, and adapt to cultural aspects. Companies in the food industry consider the model for creating value to adapt to meet customer needs, the effective use of purchasing channels, functionality of products, and technical knowledge. The companies in the furniture industry value the methods that suppliers use to capture and implement required changes, effective control of the supply chain, and the representativeness of the suppliers' brand in the market. This study captures the perception of buyer companies in relation to predominant value-adding elements and could guide decisions for the adoption of managerial actions by supplier companies focused on adding value.

Background: Photodynamic therapy (PDT) is a method of microbial reduction which can benefit periodontal treatment in areas of difficult access, such as deep pockets and furcations. The aim of this randomized controlled clinical trial was to evaluate the effects of PDT as an adjunct to full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis. Material and Methods: Twenty-two patients with at least one pocket with a probing depth (PD) of ≥7 mm and one pocket with a PD of ≥5 mm and bleeding on probing (BOP) on each side of the mouth were included, characterizing a split mouth design. The control group underwent full-mouth ultrasonic debridement and the test group received the same treatment associated with PDT. The PDT was performed on only one side of the mouth and the initial step consisted of subgingival irrigation with 0.005% methylene blue dye. Two minutes after applying the photosensitizer, the low power laser – AsGaAl (Photon Lase III – PL7336, DMC, São Carlos -São Paulo, Brazil) was applied (660 nm, 100 mW, 9 J, 90 seconds per site, 320 J/cm 2 , diameter tip 600 µm). The following clinical parameters were evaluated: plaque index, gingival index, BOP, gingival recession (GR), PD, and clinical attachment level (CAL). All parameters were collected before, 1, 3 and 6 months after treatment. Results: An improvement in BOP, PD and CAL was observed after treatment, in both groups, but without any difference between them. After 6 months, the PD decreased from 5.11±0.56 mm to 2.83±0.47 mm in the test group (p<0.05) and from 5.15±0.46 mm to 2.83±0.40 mm in the control group (p<0.05). The CAL changed, after 6 months, from 5.49±0.76 mm to 3.41±0.84 mm in the test group (p<0.05) and from 5.53±0.54 to 3.39±0.51 mm in the control group (p<0.05). Conclusion: Both approaches resulted in significant clinical improvements in the treatment of severe chronic periodontits, however, the PDT did not provide any additional benefit to those obtained with full-mouth ultrasonic debridement used alone.

OBJECTIVE: The aim of this controlled clinical trial was to evaluate the effect of topically applied povidone-iodine (PVP-I) used as an adjunct to non-surgical treatment of interproximal class II furcation involvements. MATERIAL AND METHODS: Thirty-two patients presenting at least one interproximal class II furcation involvement that bled on probing with probing pocket depth (PPD) >5 mm were recruited. Patients were randomly chosen to receive either subgingival instrumentation with an ultrasonic device using PVP-I (10%) as the cooling liquid (test group) or identical treatment using distilled water as the cooling liquid (control group). The following clinical outcomes were evaluated: visible plaque index, bleeding on probing (BOP), position of the gingival margin, relative attachment level (RAL), PPD and relative horizontal attachment level (RHAL). BAPNA (N-benzoyl-L-arginine-p-nitroanilide) testing was used to analyze trypsin-like activity in dental biofilm. All parameters were evaluated at baseline and 1, 3 and 6 months after non-surgical subgingival instrumentation. RESULTS: Six months after treatment, both groups had similar means of PPD reduction, RAL and RHAL gain (p>0.05). These variables were, respectively, 2.20±1.10 mm, 1.27±1.02 mm and 1.33±0.85 mm in the control group and 2.67±1.21 mm, 1.50±1.09 mm and 1.56±0.93 mm in the test group. No difference was observed between groups at none of the posttreatment periods, regarding the number of sites showing clinical attachment gain >2 mm. However, at 6 months posttreatment, the test group presented fewer sites with PPD >5 mm than the control group. Also at 6 months the test group had lower BAPNA values than control group. CONCLUSION: The use of PVP-I as an adjunct in the non-surgical treatment of interproximal class II furcation involvements provided limited additional clinical benefits.

OBJECTIVES: The aim of this study was to evaluate the influence of the crown shape on the outcomes of root coverage procedures. MATERIAL AND METHODS: Eighty patients with Miller class I gingival recessions in maxillary canines or premolars were selected. The recession areas were treated using the subepithelial connective tissue grafting. The following clinical parameters were analyzed: crown length (CL) and width (CW), recession height and width, probing depth, clinical attachment level, width and thickness of the keratinized tissue and percentage of root coverage achieved. These measurements were recorded at baseline and 6 months after the surgical procedure. The CW/CL ratio was calculated for each tooth and the median obtained (0.83). Patients were then ranked into two groups, according to the shape of the tooth with gingival recession: Group A - square crown shape (CW/CL values above 0.83) and Group B - long and narrow crown shape (CW/CL values below 0.83). RESULTS: No statistically significant differences (p>0.05) were found between groups in any of the clinical parameters at baseline. After 6 months, both groups presented improved clinical outcomes for all parameters analyzed compared to baseline (p>0.05). The mean percentages and standard deviations of root coverage achieved in Group A and Group B was 91.37 (16.75) and 85.49 (23.55), respectively (p>0.05). CONCLUSIONS: Crown shape did not influence the root coverage obtained with the subepithelial connective tissue graft technique.

O objetivo deste estudo foi avaliar o efeito do controle de placa supragengival sobre os parâmetros clínicos e bioquímicos da periodontite crônica. Foram selecionados 25 pacientes apresentando pelo menos 4 sítios com profundidade de sondagem > 5 mm, não fumantes e sem alterações sistêmicas relevantes. A avaliação clínica e bioquímica foi feita antes e 21 dias após a remoção dos fatores retentivos de placa, exodontia dos dentes condenados e instrução de higiene bucal. A análise estatística foi feita através do teste t de Student pareado (p<0,05) e demonstrou redução da porcentagem de sítios com sangramento à sondagem de 42,72 ± 15,83 para 35,87 ± 13,30 (p=0,002). Redução na profundidade de sondagem foi observada nos dentes anteriores (média inicial/final: 2,88 mm/2,78 mm; p=0,01) e faces interproximais (média inicial/final: 3,80 mm/3,65 mm; p=0,001). Houve aumento de 66,81% para 68,65% (p=0,03) no número de sítios com profundidade de sondagem de 1 a 3 mm e redução de 26,21% para 24,17% (p=0,04) nos de 4 a 6 mm. O valor do BAPNA apresentou redução de 51,44 ± 20,78 para 38,64 ± 12,34 (p=0,04). Baseado nesses achados pôde-se concluir que o controle de placa supragengival tem efeitos benéficos, principalmente relacionados à redução da inflamação gengival e da atividade de enzima tipo tripsina no biofilme subgengival (BAPNA).

Supragingival plaque control is a requisite for the success of any periodontal procedure. However, little is know about the effect of this procedure alone on periodontitis. The aim of this study was to determine the effect of supragingival plaque control on clinical and biochemical parameters of chronic periodontitis. Twenty-five subjects exhibiting at least 4 pockets > 5mm, non-smokers and with no relevant systemic diseases, were selected for the study. The clinical and biochemical assessments were done before and 21 days after removal of plaque retentive factors, extraction of affected teeth and instruction in oral hygiene. The statistical analysis was done with the Student paired t-test (p<0,05) and demonstrated a reduction on the percentage of sites with bleeding on probing from 42.72 ± 15.83 to 35.87 ± 13.30 (p=0.002). Reduction in probing depth was detected on anterior teeth (initial/final mean: 2.88 mm/2.78 mm; p=0.01) and interproximal sites (initial/final mean: 3.80 mm/3.65 mm; p=0.001). There was an increase from 66.81% to 68.65% in the number of sites with probing depth of 1 to 3mm and a decrease from 26.21% to 24.17% in those with probing depth of 4 to 6mm. The BAPNA results showed a decrease from 51.44 ± 20.78 to 38.64 ± 12.34 (p=0.04). This study demonstrated that supragingival plaque control provides a reduction in gingival inflammation and alterations in the subgingival microflora detected by the BAPNA test.