Many techniques have been proposed for root coverage. However, none of them presents predictable results in deep and wide recessions. OBJECTIVES: The aim of this case series report is to describe an alternative technique for root coverage at sites showing deep recessions and attachment loss >4 mm at buccal sites. MATERIAL AND METHODS: Four patients presenting deep recession defects at buccal sites (>4 mm) were treated by the newly forming bone graft technique, which consists in the creation of an alveolar socket at edentulous ridge and transferring of granulation tissue present in this socket to the recession defect after 21 days. Clinical periodontal parameters, including recession depth (RD), probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PI) and keratinized gingiva width (KGW) were evaluated by a single examiner immediately before surgery and at 1, 3, 6 and 9 months postoperatively. RESULTS: All cases showed reduction in RD and PD, along with CAL gain, although no increase in KGW could be observed. These findings suggest that the technique could favor periodontal regeneration along with root coverage, especially in areas showing deep recessions and attachment loss.

Most studies investigating the impact of oral contraceptives have been performed some years ago, when the level of sexual hormones was greater than the actual formulations. Objective: The aim of this study was to evaluate the effects of current combined oral contraceptives (COC) on periodontal tissues, correlating the clinical parameters examined with the total duration of continuous oral contraceptive intake. Material and methods: Twenty-five women (19-35 years old) taking combined oral contraceptives for at least 1 year were included in the test group. The control group was composed by 25 patients at the same age range reporting no use of hormone-based contraceptive methods. Clinical parameters investigated included pocket probing depth (PD), clinical attachment level (CAL), sulcular bleeding index (SBI) and plaque index (Pl.I). Data were statistically evaluated by unpaired t test, Pearson’s correlation test and Spearman’s correlation test. Results: The test group showed increased PD (2.228±0.011 x 2.154±0.012; p<0.0001) and SBI (0.229±0.006 x 0.148±0.005, p<0.0001) than controls. No significant differences between groups were found in CAL (0.435±0.01 x 0.412±0.01; p=0.11). The control group showed greater Pl.I than the test group (0.206±0.007 x 0.303±0.008; p<0.0001). No correlation between the duration of oral contraceptive intake, age and periodontal parameters was observed. Conclusions: These findings suggest that the use of currently available combined oral contraceptives can influence the periodontal conditions of the patients, independently of the level of plaque accumulation or total duration of medication intake, resulting in increased gingival inflammation.

Dental roots that have been exposed to the oral cavity and periodontal pocket environment present superficial changes, which can prevent connective tissue reattachment. Demineralizing agents have been used as an adjunct to the periodontal treatment aiming at restoring the biocompatibility of roots. OBJECTIVE: This study compared four commonly used demineralizing agents for their capacity of removing smear layer and opening dentin tubules. METHODS: Fifty fragments of human dental roots previously exposed to periodontal disease were scaled and randomly divided into the following groups of treatment: 1) CA: demineralization with citric acid for 3 min; 2) TC-HCl: demineralization with tetracycline-HCl for 3 min; 3) EDTA: demineralization with EDTA for 3 min; 4) PA: demineralization with 37% phosphoric acid for 3 min; 5) Control: rubbing of saline solution for 3 min. Scanning electron microscopy was used to check for the presence of residual smear layer and for measuring the number and area of exposed dentin tubules. RESULTS: Smear layer was present in 100% of the specimens from the groups PA and control; in 80% from EDTA group; in 33.3% from TC-HCl group and 0% from CA group. The mean numbers of exposed dentin tubules in a standardized area were: TC-HCl=43.8±25.2; CA=39.3±37; PA=12.1±16.3; EDTA=4.4±7.5 and Control=2.3±5.7. The comparison showed significant differences between the following pairs of groups: TC-HCl and Control; TC-HCl and EDTA; CA and Control; and CA and EDTA. The mean percentages of area occupied by exposed dentin tubules were: CA=0.12±0.17%; TC-HCl=0.08±0.06%; PA=0.03±0.05%; EDTA=0.01±0.01% and Control=0±0%. The CA group differed significantly from the others except for the TC-HCl group. CONCLUSION: There was a decreasing ability for smear layer removal and dentin tubule widening as follows: AC>TC-HCl>PA>EDTA. This information can be of value as an extra parameter for choosing one of them for root conditioning.

OBJECTIVES: The aim of this study was to evaluate the effects of non-surgical treatment of periodontal disease during the second trimester of gestation on adverse pregnancy outcomes. MATERIAL AND METHODS: Pregnant patients during the 1st and 2nd trimesters at antenatal care in a Public Health Center were divided into 2 groups: NIG - "no intervention" (n=17) or IG- "intervention" (n=16). IG patients were submitted to a non-surgical periodontal treatment performed by a single periodontist consisting of scaling and root planning (SRP), professional prophylaxis (PROPH) and oral hygiene instruction (OHI). NIG received PROPH and OHI during pregnancy and were referred for treatment after delivery. Periodontal evaluation was performed by a single trained examiner, blinded to periodontal treatment, according to probing depth (PD), clinical attachment level (CAL), plaque index (PI) and sulcular bleeding index (SBI) at baseline and 35 gestational weeks-28 days post-partum. Primary adverse pregnancy outcomes were preterm birth (<37 weeks), low birth weight (<2.5 kg), late abortion (14-24 weeks) or abortion (<14 weeks). The results obtained were statistically evaluated according to OR, unpaired t test and paired t test at 5% signifcance level. RESULTS: No signifcant differences were observed between groups at baseline examination. Periodontal treatment resulted in stabilization of CAL and PI (p>0.05) at IG and worsening of all periodontal parameters at NIG (p<0.0001), except for PI. Signifcant differences in periodontal conditions of IG and NIG were observed at 2nd examination (p<0.001). The rate of adverse pregnancy outcomes was 47.05% in NIG and 6.25% in IG. Periodontal treatment during pregnancy was associated to a decreased risk of developing adverse pregnancy outcomes [OR=13.50; CI: 1.47-123.45; p=0.02]. CONCLUSIONS: Periodontal treatment during the second trimester of gestation contributes to decrease adverse pregnancy outcomes.

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.

BACKGROUND: A new fibrin adhesive made of buffalo plasma-derived fibrinogen and a thrombin-like snake venom enzyme, has been successfully used to immobilize free gingival grafts. This case series histologically compared sutured grafts (control group) with others immobilized by using the fibrin adhesive (experimental group). CASE DESCRIPTION: The grafts were placed in the contralateral mandibular bicuspids of 15 patients, so that each subject received one treatment of each type. Five biopsies of each group were collected at 7, 14 and 45 days of healing, which were histologically and morphometrically analyzed as regards the relative volume density of the different connective tissue components. RESULTS: The sites in the control group presented a higher inflammatory cell density at 7 days and a tendency towards a lower collagen density. In the experimental group, the grafts had an appearance of more advanced healing. Tissue maturity characteristics progressed until 14 and 45 days, but no difference between groups could be noted at these times. Conclusions: Within the limits of the present study, it may be suggested that the alternative fibrin adhesive tested could represent an alternative to sutures in gingival grafts procedures.

Given that tobacco smoking habit is a risk factor for periodontal diseases, the aim of this study was to compare clinical periodontal aspects between smokers and non-smokers. The clinical status were assessed in 55 patients, 29 smokers and 26 non-smokers, aged 30 to 50 years, with mean age of 40. The clinical parameters used were: probing depth (PD), plaque index (PI), gingival index (GI), clinical attachment level (CAL), gingival recession (GR) and gingival bleeding index (GBI) for arches (upper and lower ) and teeth (anterior and posterior). Tooth loss was also evaluated in both groups. Multiple regression analysis showed: tendency of greater probing depth and clinical attachment level means for smokers; greater amount of plaque in smokers in all regions; greater gingival index means for non-smokers with clinical significance (p<0.05) in all regions. Although, without statistical significance, the analysis showed greater gingival bleeding index means almost always for non-smokers; similar gingival recession means in both groups and tendency of upper tooth loss in smokers and lower tooth loss in non-smokers. The findings of this study showed that clinical periodontal parameters may be different in smokers when compared to non-smokers and that masking of some periodontal signs can be a result of nicotine's vasoconstrictor effect.

A Epidemiologia é o estudo da saúde e da doença nas populações e de como esses estados são influenciados pela hereditariedade, biologia, ambiente físico e social e comportamento pessoal. Existem vários estudos epidemiológicos na população brasileira porém poucos sobre a influência de fatores de risco nas condições periodontais. Este estudo transversal objetivou avaliar a influência da idade, sexo, placa bacteriana e fumo na doença periodontal em uma amostra da cidade de Bauru. Os dados sobre as condições periodontais foram obtidos de 380 pacientes da Universidade de São Paulo, sendo registradas medidas de profundidade de sondagem, nível de inserção clínica e índice de placa de 4 sítios de todos os dentes. A influência da idade, sexo e fumo foram avaliadas utilizando-se a Estatística descritiva e a Análise de Variância (ANOVA) e o papel da placa bacteriana, por meio do coeficiente de correlação de Pearson. Os resultados mostraram um aumento nas médias de profundidade de sondagem e nível de inserção e um maior número de sítios com perdas severas com o avanço da idade. A correlação entre a porcentagem de sítios com placa e os parâmetros periodontais foi positiva porém fraca. O sexo masculino apresentou médias significantemente maiores de nível de inserção do que o sexo feminino. Os fumantes obtiveram médias significantemente maiores de profundidade de sondagem e de nível de inserção quando comparados aos não-fumantes. A idade, hábito de fumar, sexo masculino e porcentagem de sítios com placa estão associados a maior destruição periodontal, sendo fatores importantes no diagnóstico da doença periodontal nessa população brasileira.

Epidemiology is the study of health and disease in populations, and of how these conditions are influenced by heredity, biology, physical environment, social environment, and personal behavior. There are many epidemiological studies in Brazilian population but few about the influence of some risk factors in periodontal conditions. This cross-sectional study was performed to assess the influence of age, sex, plaque and smoking on periodontal disease in a population from Bauru (Brazil). Data concerning periodontal status were collected from 380 patients in the University of São Paulo (USP). Measurements of periodontal pocket depths (PPD), clinical attachment levels (CAL), plaque index (PI) of four sites in all teeth were registered. The influence of age, sex and smoking habits on the periodontal parameters were statistically evaluated using descriptive statistical and ANOVA. The correlation between plaque and periodontal parameters was analyzed by Pearson's correlation coefficient. The results showed an increase in the mean of periodontal destruction (PPD and CAL) and a higher number of sites with severe losses with increasing age. Correlation among percentage of sites with plaque and periodontal parameters (PPD and CAL) were positive but weakly related. The male group showed significantly higher means of CAL than the female. Smokers had significantly higher PPD and CAL means than non-smokers. Aging, smoking habit, male sex, and percentage of sites with plaque were associated with a great increase of periodontal destruction, being important factors in the diagnosis of the periodontal disease in this Brazilian population.

Recessão gengival foi relatada em 380 indivíduos adultos com mais de 20 anos de idade, pacientes em tratamento ou indivíduos que procuravam atendimento odontológico na Faculdade de Odontologia de Bauru. Durante avaliação clínica, realizada por apenas um examinador, em todos os dentes, quatro superfícies foram consideradas (mesial, vestibular, distal e lingual). Recessão gengival foi considerada presente quando mais de 1mm de raiz estivesse exposta e sua amplitude vertical foi medida em milímetros da junção cemento-esmalte a margem gengival. As recessões foram ainda classificadas segundo os parâmetros da classificação proposta por Miller, em 1985. Recessão gengival foi encontrada em pelo menos uma superfície dentária em aproximadamente 89% dos indivíduos avaliados. A prevalência, extensão e severidade desta condição clínica aumentaram com o avanço da idade. As recessões classe I foram as mais freqüentes, mas houve um aumento gradual das recessões classe III e IV à medida que indivíduos mais idosos foram avaliados. Os dentes inferiores tiveram mais superfícies com recessão do que os superiores, e os mais freqüentemente envolvidos foram os incisivos inferiores. Diante da elevada prevalência de recessão gengival em adultos, os cirurgiões-dentistas devem estar atentos à importância clínica destas alterações e ao diagnóstico de seus fatores causais.

The gingival recession was assessed in 380 adult individuals aged more than 20 years and comprised both subjects being treated and looking for treatment at Bauru Dental School. Clinical evaluation was conducted by a single examiner in all teeth and involved analysis of four dental aspects (mesial, buccal, distal and lingual). The gingival recession was regarded as present whenever more than 1mm of root surface was exposed, and its vertical width was measured in millimeters from the cementoenamel junction to the gingival margin. The recessions were further scored following the criteria suggested by Miller in 1985. Gingival recession was observed in at least one dental surface in about 89% of the individuals analyzed. The prevalence, extension and severity of this clinical aspect increased with age. Class I recessions were the most frequent, yet there was a gradual increase of Class III and IV recessions as older subjects were evaluated. The mandibular teeth displayed more surfaces with gingival recession than the maxillary teeth and the mandibular incisors were the most affected teeth. Such high prevalence of gingival recession in adult patients demonstrates that dental professionals should provide attention to the clinical relevance of such alterations, as well as to the diagnosis of the etiologic factors.

A terapia com laser em baixa intensidade visa a biomodulação dos tecidos para se obter supressão da dor, redução do edema, e aceleração da cicatrização. O objetivo deste estudo foi avaliar, clinicamente, os efeitos do laser diodo de arseneto de gálio e alumínio (GaAlAs) - 670nm- na cicatrização de gengivoplastias em 11 pacientes. As cirurgias foram realizadas nas regiões anteriores superior e/ou inferior. O lado direito (teste) foi irradiado, na forma pontual, com 4J/cm² por ponto, em três locais diferentes. A aplicação do laser foi feita a cada 48h, durante uma semana, totalizando quatro sessões. O lado esquerdo (controle) não foi irradiado. A avaliação clínica foi feita por cinco periodontistas, através de fotografias dos períodos pós-operatórios de 7,15,21, 30 e 60 dias. Os examinadores apontaram o lado mais bem cicatrizado ou se ambos estavam iguais. Para análise estatística dos dados clínicos, foi utilizado o teste dos sinais com um nível de significância de 5% (p<0,05). Os resultados mostraram que havia preferência ora pelo lado teste, ora pelo lado controle até o período de 21 dias e nos períodos subseqüentes ambos os lados foram considerados iguais. A diferença entre os lados estudados não foi estatisticamente significante, sugerindo que o laser não acelerou a cicatrização da mucosa oral.

Low-intensity laser therapy aims at pain suppression, edema reduction and acceleration of wound healing. The main goal of this study was to clinically evaluate the effects of Aluminum Gallium Arsenate laser - 670nm in wound healing after gingivoplasty in 11 patients. Surgery was performed in anterior superior and/or inferior regions. The right side of the patient (test group) received a laser energy density of 4J/cm², in a 48-hour interval, during one week, totalizing four sessions. The irradiation was punctual in a contact mode in three points. The left side did not receive irradiation (control group). Clinical evaluation was performed by five specialists in periodontology through photography of the treated areas at post-surgical periods of 7, 15, 21,30,60 days. The observers pointed the best healed side. The Sign test was used for statistical analysis with a confidence level of 5% (P<0.05). The examiners found a better pattern of healing sometimes in the test and sometimes in the control group until 21 days after surgery. After this period there was no apparent difference between them. There was no statistical difference between the sides (p>0.05). These results have shown that low-intensity laser therapy did not accelerate oral mucosa healing after gingivoplasty.

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.

Procurou-se avaliar a condição periodontal e a presença de periodontopatógenos em 30 mães brasileiras, com idades entre 21-40 anos (28,4 ± 4,49 anos) e seus filhos, com 5-6 anos de idade, considerando que elas possam ser fonte de transmissão para seus filhos e influenciar suas condições clínicas e bacteriológicas. Além de determinar o índice de placa (IP), índice gengival (IG) de mães e filhos, e a profundidade de sondagem periodontal (PS), apenas das mães, avaliaram-se quatro amostras de placa dental subgengival de mães e filhos e uma amostra de saliva total estimulada das mães para a presença de Actinobacillus actinomycetemcomitans (Aa), Prevotella nigrescens (Pn), Porphyromonas gingivalis (Pg) e Treponema denticola (Td), pela técnica de "slot immunoblot" (SIB). As médias e desvios-padrão para as variáveis clínicas em mães e filhos foram, respectivamente: 1,86 ± 0,67 e 1,64 ± 0,68, para o IP e 1,24 ± 0,67 e 0,82 ± 0,37, para o IG, enquanto apenas nas mães, a PS total foi 1,81 ± 0,69 e a PS dos 4 sítios, 4,03 ± 1,40. O teste de Wilcoxon revelou diferença significante (p < 0,05) entre mães e filhos apenas para o IG. As bactérias mais prevalentes nas mães, em ordem decrescente, foram, Aa, Pn, Pg e Td. As crianças demonstraram padrão de higiene oral e de ocorrência bacteriana semelhante aos de suas mães, apesar da maioria delas não apresentar quantidade suficiente de placa subgengival.A comparação entre amostras revelou diferença estatisticamente significante (p < 0,05), com a saliva sempre exibindo os maiores valores e maior positividade, demonstrando ser um indicador de colonização oral e poder funcionar como veículo para a transmissão de periodontopatógenos de mães para filhos.

The aim of this study was to assess the periodontal condition and the presence of putative periodontal pathogens in 30 Brazilian mothers, aging 21-40 years (28.4 ± 4.49 years), and in their children, aging 5-6 years, since mothers can be a source of pathogens and, thus, influence their children's bacteriological and clinical condition. Besides assessing the plaque index (PI), gingival index (GI) and pocket probing depth (PD), the survey analyzed four subgingival dental plaque samples from mothers and children, as well as a sample of stimulated saliva from mothers. Those samples were analyzed by means of the slot immunoblot (SIB) technique, in order to determine the presence of Actinobacillus actinomycetemcomitans (Aa), Prevotella nigrescens (Pn), Porphyromonas gingivalis (Pg) and Treponema denticola (Td). The mean values and standard deviations of the evaluated clinical variables for mothers and children were, respectively: 1.86 ± 0.67 and 1.64 ± 0.68 for PI, and 1.24 ± 0.67 and 0.82 ± 0.37, for GI. Only for mothers, the total PD was 1.81 ± 0.69 mm, and the PD of four sites was 4.03 ± 1.40 mm. The Wilcoxon test revealed significant difference (p < 0.05) between mothers and their children only as to GI. The most prevalent bacteria in mothers were, in decreasing order: Aa, Pn, Pg and Td. The children presented patterns of oral hygiene and bacterial profiles similar to those of their mothers, in spite of the fact that most of them did not present enough subgingival plaque for testing. The comparison between mothers' subgingival dental plaque and saliva samples revealed statistically significant differences (p < 0.05) for all bacteria, with greater positivity and scores in the saliva, which demonstrates that it is an indicator of oral colonization and can work as a vehicle for the transmission of periodontopathogens from mothers to their children.