Abstract Objective: This study assessed the efficacy of two adjunct therapies (antibiotic and probiotic) for periodontal treatment based on clinical and immunological parameters in patients with Stage II and III Grade B periodontitis. Methodology: 45 patients were randomly allocated into three groups: control group (CG); antibiotic group (GAtb), in which 500 mg amoxicillin + 400 mg metronidazole were used; and probiotic group (GProb), for which Lactobacillus reuteri was used. Patients received medications after undergoing periodontal debridement. Clinical and immunological parameters were assessed at baseline, 30 days, and 90 days. Results: All therapies reduced bleeding on probing (BoP) in the evaluated periods, and the GAtb had a greater reduction at 90 days (p=0.03). The GProb group showed better results for plaque index (PI) and gingival recession (GR) compared to the GAtb at 90 days (p=0.0014; p=0.006). The area of inflammation (PISA Index) significantly decreased in all therapies in the evaluated periods. Therapies had no significant differences regarding moderate pockets. The GAtb had a greater reduction in probing depth (PD) for deep pockets (p=0.03) at 90 days and in the number of deep pocket sites at 30 days (p=0.04). The occurrence of adverse effects was commonly reported in the GAtb as a percentage per patient. The GAtb had a significant reduction in the concentration of interleukins IL-1β and IL-8 and an increase in IL-10 and TNF-α. The CG had a reduction in IL-6 and IL-1 β, whereas in the GProb there was no difference. Conclusion: After three months, none of the adjuvant therapies provided any additional benefit for subgingival instrumentation.

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 Objective To compare two corticotomy surgical protocols in rats to verify whether they alter conventional orthodontic movement. Methodology Sixty Wistar rats were divided into three groups – orthodontic movement (CG), orthodontic movement and corticotomy (G1) and orthodontic movement with corticotomy and decortication (G2) – and euthanized after 7 and 14 days. Tooth movement (mm), bone volume fraction and bone volume ratio to total volume (BV/TV), and bone mineral density (BMD) were evaluated by micro-CT. The total amount of bone was measured in square millimeters and expressed as the percentage of bone area in the histomorphometry. The number of positive TRAP cells and RANK/RANKL/OPG interaction were also investigated. Results Day 14 showed a statistically significant difference in orthodontic tooth movement in CG compared with G1 (7.52 mm; p=0.009) and G2 (7.36 mm; p=0.016). A micro-CT analysis revealed a difference between CG, G1 and G2 regarding BV/TV, with G1 and G2 presenting a lower BV/TV ratio at 14 days (0.77 and 0.73 respectively); we found no statistically significant differences regarding BMD. There was a difference in the total amount of bone in the CG group between 7 and 14 days. At 14 days, CG presented a significantly higher bone percentage than G1 and G2. Regarding TRAP, G2 had more positive cells at 7 and 14 days compared with CG and G1. Conclusion Corticotomy accelerates orthodontic movement. Decortication does not improve corticotomy efficiency.

Resumo O objetivo deste estudo foi avaliar a probabilidade de falha de dois tipos de parafusos para pilar protético após a compressão e analisar a distribuição da tensão com o método dos elementos finitos. Sessenta (60) restaurações unitárias foram montadas em implantes de titânio (e-fix, A.S. Technology - Titanium Fix). Os grupos foram divididos em parafusos convencionais (parafuso de pescoço 1,5 ø mm) e parafuso experimental (parafuso de pescoço estreitado com 1,2 ø mm). As amostras foram sujeitas ao teste de compressão de acordo com ISO 14801. Os espécimes fraturados foram submetidos a estereomicroscopia para a mensuração dos parafusos restantes dentro do implante e caracterização da origem da fratura. Os espécimes representativos foram analisados por microscopia eletrônica de varredura. Para o método de elementos finitos (FEM), utilizou-se um modelo 3D idêntico dos dois grupos de teste in vitro com condições semelhantes (30º, 100 N). A tensão no parafuso do pilar foi analisada pelo critério de von-Mises. Os resultados de resistência a compressão foram 4132,5 ± 76 MPa e 4528,2 ± 127,2 para grupos convencionais e experimentais, respectivamente. Durante a microscopia, a média do remanescente do parafuso restante dentro dos implantes foi de 0,97 ± 0,23 e 1,32 ± 0,12 mm para os grupos convencionais e experimentais, respectivamente. Em FEM, o grupo convencional mostrou tensão concentrada em uma região desfavorável (pico de 39,23 MPa), enquanto o grupo experimental apresentou mais áreas de tensão, porém menor concentração do que o grupo convencional (36,6 MPa). Ao usar a geometria experimental testada, o parafuso do pilar pode ter sua resistência melhorada e a origem da falha pode ser mais favorável à resolução clínica.

Abstract The aim of this study was to evaluate the failure probability of two types of abutment screws after compressive load and to analyze the stress distribution with finite element method. Sixty (60) single-tooth implant restorations were assembled on titanium implants (e-fix, A.S. Technology - Titanium Fix). The groups were divided into Conventional screw (Screw neck 1.5 ø mm) and Experimental screw (Screw neck constricted with 1.2 ø mm). Specimens were subjected to single load to failure with compressive test according ISO 14801. The fractured specimens were subjected to stereomicroscopy for measurement of remaining screws inside the implant and characterization of fracture origin. Representative specimens were analyzed by scanning electronic microscopy. For finite element method (FEM), an identical 3D model of the two in vitro test groups were used with similar conditions (30º, 100 N load). The stress in the abutment screw was analyzed by von-Mises criteria. The results of strength means were 4132.5 ± 76 MPa and 4528.2 ± 127.2 for conventional and experimental groups, respectively. During microscopy, the mean (mm) of the remaining screw piece inside the implants were 0.97 ± 0.23 and 1.32 ± 0.12 for conventional and experimental groups, respectively. In FEM, the conventional group showed stress concentered in an unfavorable region (peak of 39.23 MPa), while the experimental group showed more stress areas but less concentration than the conventional group (36.6 MPa). In using the tested experimental geometry, the abutment screw can have its strength improved, and the origin of failure can be more favorable to clinical resolution.

Abstract Objective Considering the global public health problem of smoking, which can negatively influence bone tissue repair, the aim of this study is to analyze the influence of photobiomodulation therapy (PBM) on calvaria defects created surgically in specimens under the effect of cigarette smoke and analyzed with use of histomorphometric and immunohistochemistry techniques. Methodology Calvaria defects 4.1 mm in diameter were surgically created in the calvaria of 90-day-old rats (n=60) that were randomly divided into 4 experimental groups containing 15 animals each: control group (C), smoking group (S), laser group (L), and smoke associated with laser group (S+L). The animals were subjected to surgery for calvaria defects and underwent PBM, being evaluated at 21, 45, and 60 days post-surgery. The specimens were then processed for histomorphometric and immunohistochemistry analyses. The area of bone neoformation (ABN), percentage of bone neoformation (PBNF), and the remaining distance between the edges of the defects (D) were analyzed histometrically. Quantitative analysis of the TRAP immunolabeled cells was also performed. The data were subjected to analysis of variance (ANOVA) in conjunction with Tukey’s test to verify the statistical differences between groups (p<0.05). Results The smoking group showed less ABN compared to the other experimental groups in all periods, and it also showed more D at 21 days compared to the remaining groups and at 45 days compared to the laser group. The smoking group showed a lower PNBF compared to the laser group in all experimental periods and compared to smoking combined with LLLT group at 21 days. Conclusions PBM acted on bone biomodulation, thus stimulating new bone formation and compensating for the negative factor of smoking, which can be used as a supportive therapy during bone repair processes.

Resumo Introdução A quantidade de pacientes hipertensivos está aumentando e, a profilaxia com jato de bicarbonato de sódio é bastante empregada na prática clínica usando grande quantidade dessa substância em um período curto de tempo que poderia aumentar a pressão arterial. Objetivo Foi avaliado a alteração da pressão arterial antes e após os dois métodos de profilaxia dental e obtido a opinião de conforto do paciente em relação a esses métodos. Material e método Selecionou-se 20 pacientes, na faixa etária de 18 a 30 anos, que necessitavam de profilaxia para remoção de biofilme dental e foram submetidos aos três tipos diferentes de tratamento: jato de bicarbonato de sódio (G1), profilaxia convencional (G2), e controle (G3), em intervalos de um mês entre eles. Os pacientes foram divididos de forma randomizada. As aferições realizaram-se antes da profilaxia, imediatamente ao fim do procedimento, 15 e 30 minutos após o término do tratamento. O conforto do paciente foi medido por meio de uma Escala Analógica Visual (VAS) após o final de cada tratamento. Os dados foram analisados por meio de teste de Variância. Resultado Houve diferença estatisticamente significante quanto ao conforto dos procedimentos, sendo G2 e G3 melhores que G1. Observou-se aumento da pressão arterial diastólica no grupo jato de bicarbonato de sódio imediatamente após a profilaxia. Conclusão A profilaxia convencional é mais confortável do ponto de vista do paciente e não altera a pressão arterial.

Abstract Introduction The number of hypertensive patients is increasing and prophylaxis with bicarbonate jet are widely performed in clinical practice using large amounts of this substance in a short period of time, which may lead to increased arterial pressure. In the literature there are several studies that analyze the effect of sodium bicarbonate jet on the biofilm and dental structures, but not report the effect on arterial pressure. Aim Evaluated the change in arterial pressure before and after two procedures of dental prophylaxis, jet baking soda application and conventional prophylaxis, and patient opinion of the comfort of each system was obtained. Material and method We selected 20 patients aged 18 to 30 in need of prophylaxis to remove biofilm. The patients were placed into three different treatment groups: sodium bicarbonate jet (G1), conventional prophylaxis (G2) and control (G3), with a one month interval between treatments. Patients were divided into groups randomly. Measurements were performed immediately before and after the procedure, 15 and 30 minutes after the end of treatment. Patient comfort was measured using a Visual Analog Scale (VAS) at the end of each treatment. Data were analyzed by analysis of variance. Result There was a statistically significant difference in the comfort of the procedures, with G2 and G3 being better than G1. Additionally, an increase in the diastolic blood pressure was observed in sodium bicarbonate jet group evaluated just after the procedure. Conclusion The conventional prophylaxis is more comfortable from the patient stand point and does not alter arterial pressure.

Objective The aim of this paper was to evaluate the repair of onlay autogenous bone grafts covered or not covered by an expanded polytetrafluoroethylene (e-PTFE) membrane using immunohistochemistry in rats with induced estrogen deficiency. Material and Methods Eighty female rats were randomly divided into two groups: ovariectomized (OVX) and with a simulation of the surgical procedure (SHAM). Each of these groups was again divided into groups with either placement of an autogenous bone graft alone (BG) or an autogenous bone graft associated with an e-PTFE membrane (BGM). Animals were euthanized on days 0, 7, 21, 45, and 60. The specimens were subjected to immunohistochemistry for bone sialoprotein (BSP), osteonectin (ONC), and osteocalcin (OCC). Results All groups (OVX+BG, OVX+BMG, SHAM+BG, and SHAM+BMG) showed greater bone formation, observed between 7 and 21 days, when BSP and ONC staining were more intense. At the 45-day, the bone graft showed direct bonding to the recipient bed in all specimens. The ONC and OCC showed more expressed in granulation tissue, in the membrane groups, independently of estrogen deficiency. Conclusions The expression of bone forming markers was not negatively influenced by estrogen deficiency. However, the markers could be influenced by the presence of the e-PTFE membrane.

The aim of this study was to evaluate the resorption process during the repair of autogenous bone grafts with or without coverage by an expanded polytetrafluoroethylene (e-PTFE) membrane in female rats with estrogen deficiency using the immunohistochemical technique. Eighty female rats were randomly divided into two groups (OVX and SHAM). The 40 female rats in the OVX group were subjected to ovariectomy, and the 40 female rats in the SHAM group were subjected to simulated ovariectomy. The two groups were further divided in subgroup E, which was subjected to surgery for placement of autogenous bone graft (ABG), and subgroup ME, in which the ABG was covered with an e-PTFE membrane. The animals were killed at 0, 7, 21, 45 and 60 days. The specimens were analyzed using immunohistochemistry for the bone resorption markers RANK, RANK-L and Osteoprotegerin (OPG). A higher remodeling rate was observed at 7 and 21 days after the autogenous bone grafts, when the markers were more intensely expressed. At the final time point, the specimens presented similar characteristics to those observed at the initial time point. The expression of immunohistochemical markers was not altered by the estrogen deficiency. The presence of the e-PTFE membrane delayed the bone resorption process, influencing the immunohistochemical expression of markers.

INTRODUÇÃO: A literatura vem relatando condições inadequadas de higiene oral de pacientes em unidade de terapia intensiva (UTI) e a ocorrência de Pneumonia associada à ventilação mecânica em cerca de 9%-27% de todos os pacientes intubados. OBJETIVO: O objetivo deste estudo foi avaliar condições orais de pacientes críticos e correlacionar com a presença de pneumonia associada à ventilação mecânica. MATERIAL E MÉTODO: Vinte e três pacientes foram categorizados da seguinte maneira: com a doença periodontal e com pneumonia associada à ventilação mecânica, com doença periodontal e sem pneumonia associada à ventilação mecânica, sem doença periodontal e com pneumonia associada à ventilação mecânica e sem doença periodontal e sem pneumonia associada à ventilação mecânica. Foram utilizados na avaliação os índices de placa, de doença periodontal e índice de cariados, perdidos e obturados. RESULTADO: Não houve diferença estatisticamente significante na incidência da doença periodontal em relação à pneumonia associada à ventilação mecânica, mas o número de dentes e superfícies com perda de inserção acima de 4 mm sempre foi maior em pacientes com pneumonia associada à ventilação mecânica. CONCLUSÃO: A extensão da doença periodontal pode contribuir para o aparecimento de pneumonia associada à ventilação mecânica. No entanto, são necessários estudos com uma amostra maior para validar essa relação.

INTRODUCTION: Literature has reported inadequate oral hygiene conditions in Intensive Care Unit (ICU) patients and the occurrence of Ventilator-associated pneumonia in about 9%-27% of all intubated patients. OBJECTIVE: The aim of this study was to evaluate ICU patient's oral conditions and correlate this with the presence of ventilator-associated pneumonia. MATERIAL AND METHOD: Twenty-three patients were categorized in the following way: with periodontal disease and ventilator-associated pneumonia, with periodontal disease and without ventilator-associated pneumonia, without periodontal disease and with ventilator-associated pneumonia, and with neither periodontal disease nor ventilator-associated pneumonia. The periodontal disease index, plaque index, and decay-missing-filled index were used in the assessment. RESULT: There was no statistically significant difference in the incidence of periodontal disease with respect to ventilator-associated pneumonia, but the number of teeth and surfaces with attachment loss above 4 mm was always greater in patients with ventilator-associated pneumonia. CONCLUSION: The extent of periodontal disease may contribute to the onset of ventilator-associated pneumonia. However, studies with a larger sample are needed to validate this relationship.

OBJECTIVE: This study was designed to evaluate, histomorphometrically, the association of platelet-rich plasma (PRP) and bioactive glass (BG) in the treatment of periodontal intrabony defects. MATERIAL AND METHODS: Nine mongrel dogs were included in the study. Three-wall intrabony defects were surgically created at the mesial and distal aspect of first mandibular molar and exposed to plaque accumulation for 1 month. The defects were randomly assigned to the groups: control, BG, PRP, PRP+BG. Dogs were sacrificed 90 days after the surgeries. The histometric parameters evaluated were: length of sulcular and junctional epithelium, connective tissue adaptation, new cementum, new bone, defect extension and area of new bone filling the defect. RESULTS: A superior area of new bone was observed in PRP+BG and BG (13.80±2.32 mm² and 15.63±2.64 mm², respectively) when compared to the other groups (8.19±1.46 mm² and 8.81±1.47 mm² for control and PRP, respectively). No statistically significant differences were observed in the remaining parameters. CONCLUSIONS: Within the limits of this study, it may be concluded that PRP failed to provide statistically significant improvements in the histometric parameters.