According to previous studies, bacterial infection plays the most important role in the late fail... more According to previous studies, bacterial infection plays the most important role in the late failures of dental implants. Peri-implantitis has been described as a site-specific infection that causes soft tissue inflammation and bone loss around osseointegrated implants that have performed masticatory functions. To reduce the number of pathogenic species and improve the clinical parameters (that is, probing depth, bleeding on probing, and suppuration) around dental implants, several anti-infective therapies have been developed for peri-implantitis. However, recent reviews have not identified sufficient evidence to support an ideal anti-infective protocol for this disease. This article presents a case of advanced peri-implantitis that was treated with a single surgical anti-infective mechanical therapy. A follow-up visit 12 months post-treatment showed improved clinical features.
The influence of diabetes mellitus (DM) on the hemodynamics of periodontal tissues has not been a... more The influence of diabetes mellitus (DM) on the hemodynamics of periodontal tissues has not been assessed previously. The primary objective of this study was to validate optical spectroscopy as a periodontal diagnostic tool for subjects with type 2 DM and chronic periodontitis. Using a portable optical near-infrared spectrometer, optical spectra were obtained from healthy (n = 127), gingivitis (n = 115), and periodontitis (n = 109) sites of 65 subjects with type 2 DM and chronic periodontitis. Healthy (n = 65) sites of 15 nondiabetic subjects without periodontitis were used as controls. A modified Beer-Lambert unmixing model that incorporates a nonparametric scattering-loss function was used to determine the relative contribution of deoxygenated hemoglobin and oxygenated hemoglobin (HbO2 ) to the overall spectrum. The balance between tissue oxygen delivery and oxygen utilization in periodontal tissues was assessed. In diabetic subjects, tissue oxygen saturation and HbO2 concentration were significantly decreased in the periodontitis sites (p < 0.01) compared with the healthy and gingivitis sites. Furthermore, tissue oxygenation in healthy sites of control subjects was significantly higher than that in sites of diabetic subjects (p < 0.01). In summary, the results of this study suggest that optical spectroscopy can monitor the hemodynamic profile in diabetic subjects with chronic periodontitis. Furthermore, healthy sites of diabetic subjects presented lower tissue oxygenation than did those of nondiabetic subjects.
Background: This 6-month study evaluated the effects of resin-modified glass-ionomer cement (RMGI... more Background: This 6-month study evaluated the effects of resin-modified glass-ionomer cement (RMGI) and microfilled composite (MC) subgingival restorations on periodontal tissues and subgingival biofilm.
We have recently developed a periodontal diagnostic tool that was validated in non-smokers with p... more We have recently developed a periodontal diagnostic tool that was validated in non-smokers with periodontitis. Tobacco smoking is a recognized risk factor for periodontal diseases that can mask gingival bleeding and lead to a false negative diagnosis. Therefore, the purpose of current study is to further validate this instrument in smokers with periodontal diseases. Using a portable optical near-infrared spectrometer, optical spectra were obtained, processed and evaluated from healthy (n = 108), gingivitis (n = 100), and periodontitis (n = 79) sites of 54 systemically healthy smokers. A modified Beer-Lambert unmixing model that incorporates a non-parametric scattering loss function was used to determine the relative contribution of deoxygenated haemoglobin (Hb) and oxygenated haemoglobin (HbO2 ) to the overall spectrum. The balance between tissue oxygen delivery and utilization in periodontal tissues was then assessed. Tissue oxygen saturation was significantly decreased in the gingivitis (p = 0.016) and periodontitis (p = 0.007) sites, compared to the healthy sites. There was a trend towards increased concentration of Hb and decreased concentration of HbO2 from healthy to diseased sites, without statistical significance (p > 0.05). Optical spectroscopy can determine tissue oxygenation profiles of healthy and diseased sites in smokers. The spectral profile of periodontal sites in smokers generally resembles those from non-smoking patients.
The aim of this randomized controlled clinical trial was to evaluate the clinical effects of chlo... more The aim of this randomized controlled clinical trial was to evaluate the clinical effects of chlorhexidine (CHX) application in a full-mouth disinfection (FMD) protocol in poorly controlled type-2 diabetic subjects with generalized chronic periodontitis. Thirty-eight subjects were randomly assigned into FMD group (n=19): full-mouth scaling and root planing (FMSRP) within 24 h + local application of CHX gel + CHX rinses for 60 days or Control group (n = 19): FMSRP within 24 h + local application of placebo gel + placebo rinses for 60 days. Clinical parameters, glycated haemoglobin and fasting plasma glucose were assessed at baseline, 3, 6 and 12 months post-therapies. All clinical parameters improved significantly at 3, 6 and 12 months post-therapies for both groups (p < 0.05). There were no significant differences between groups for any clinical parameters, and glycemic condition at any time-point (p > 0.05). The treatments did not differ with respect to clinical parameters, including the primary outcome variable (i.e. changes in clinical attachment level in deep pockets), for up to 12 months post-treatments.
Objectives: The aim of this study was to evaluate the clinical and microbiological effects of mec... more Objectives: The aim of this study was to evaluate the clinical and microbiological effects of mechanical anti-infective therapies for mucositis and peri-implantitis.
The aim of the present case series was to evaluate the effects of a surgical anti-infective mecha... more The aim of the present case series was to evaluate the effects of a surgical anti-infective mechanical therapy for peri-implantitis on clinical parameters and tumor necrosis factor-alpha (TNF-alpha) levels at 12 months post-therapy. Ten patients with peri-implantitis were treated with open surgical debridement, abrasive sodium carbonate air-powder, and resin curets. Clinical parameters were recorded before and 3 and 12 months after therapy. At these time points, the total amounts of TNF-alpha in the peri-implant crevicular fluid were measured by enzyme-linked immunosorbent assay. At 3 and 12 months, the anti-infective therapy resulted in significant improvements in all clinical parameters (P <0.05). Moreover, the total amount of TNF-alpha was significantly reduced at 3 and 12 months after therapy compared to baseline (P <0.05), paralleling the changes in mean probing depth and bleeding on probing. The anti-infective mechanical therapy reduced the crevicular levels of TNF-alpha in sites affected by peri-implantitis over a period of 12 months, and this phenomenon was associated with improvements in clinical parameters.
Background: This study evaluated the clinical and metabolic effects of full-mouth scaling and roo... more Background: This study evaluated the clinical and metabolic effects of full-mouth scaling and root planing (FMSRP) compared to partial-mouth scaling and root planing (PMSRP) in patients with type 2 diabetes and chronic periodontitis, and it assessed the impact of the glycemic status on the clinical and metabolic response to periodontal therapy.
Objective: This study assessed gene expression by quantitative polymerase chain reaction of infla... more Objective: This study assessed gene expression by quantitative polymerase chain reaction of inflammatory-[interleukin (IL)-12, tumor necrosis factor-a (TNF-a), IL-4, and IL-10] and osteoclastogenesis-related factors [receptor activator of NF-kB ligand (RANKL) and osteoprotegerin (OPG)] in sites exhibiting different severities of peri-implant disease.
The objectives of this study were to clinically and immunologically assess the effects of mechani... more The objectives of this study were to clinically and immunologically assess the effects of mechanical anti-infective therapies for mucositis and peri-implantitis and to compare the levels of cytokines in untreated and treated peri-implant diseased sites to healthy ones. Titanium dental implants were assigned to one of the following groups: healthy (n = 10) = control; mucositis (n = 10) = mechanical debridement using abrasive sodium carbonate air-powder and resin curets; and peri-implantitis (n = 20) = open surgical debridement using abrasive sodium carbonate air-powder and resin curets. Visible plaque accumulation, marginal bleeding, bleeding on probing, suppuration, and probing depth were assessed at baseline for all groups and at 3 months after therapies for diseased groups. At these times, the total amounts of interleukin (IL)-4, -10, and -12, tumor necrosis factor-alpha (TNF-alpha), receptor activator of nuclear factor-kappa B ligand (RANKL), and osteoprotegerin (OPG) in the peri-implant crevicular fluid (PICF) were measured by enzyme-linked immunosorbent assay. At 3 months, the anti-infective treatments resulted in a significant improvement in all clinical parameters for mucositis and peri-implantitis (P <0.05). Moreover, the total amounts of TNF-alpha in PICF were significantly higher in untreated diseased implants compared to healthy ones, and the OPG/RANKL ratio was higher for healthy implants than for untreated peri-implantitis (P <0.05). TNF-alpha levels were significantly reduced for both diseased groups (P <0.05), achieving the same level as the healthy group at 3 months after therapies (P >0.05). The proposed anti-infective therapies may locally modulate the levels of TNF-alpha and the OPG/RANKL ratio and improve clinical parameters around peri-implant tissues.
PM: Cytokine levels in sites of chronic periodontitis of poorly controlled and well-controlled ty... more PM: Cytokine levels in sites of chronic periodontitis of poorly controlled and well-controlled type 2 diabetic subjects.
Rationale: Although recent studies have suggested a role for the receptor activator of nuclear fa... more Rationale: Although recent studies have suggested a role for the receptor activator of nuclear factor B ligand (RANKL) in the late stages of atherosclerosis (eg, plaque destabilization and rupture), the underlying mechanisms and subsequent events are unclear.
A história do material mais utilizado na construção civil I In nt tr ro od du uç çã ão o a ao o C... more A história do material mais utilizado na construção civil I In nt tr ro od du uç çã ão o a ao o C Co on nc cr re et to o A Ar rm ma ad do o Então, a partir deste momento, os esforços de tração passam a ser absorvidos pelas armaduras de aço. Nas estruturas de concreto armado, os esforços atuantes nas armaduras são decorrentes das ações aplicadas à superfície externa da estrutura após a sua construção. Isso significa que as tensões e deformações que surgem nas armaduras são exclusivamente decorrentes do carregamento externo à peça onde elas estão inseridas. Portanto, as armaduras são solicitadas em consequência das deformações do concreto da própria estrutura. Assim, as armaduras acompanham passivamente as deformações da estrutura, por isso, no concreto armado elas são chamadas de armaduras passivas. Quando o concreto endurece, formado a peça estrutural, o concreto e suas armaduras passam a trabalhar solidariamente, isto é, não existe escorregamento relativo entre os dois materiais. Esta é a hipótese fundamental da teoria do concreto armado. No concreto protendido, utilizando dispositivos adequados, as armaduras de protensão são tracionadas durante a construção da estrutura, armazenando tensões residuais permanentes. Embora as armaduras de protensão também tenham seus esforços alterados pelo carregamento externo à peça onde elas estão inseridas, essas alterações são relativamente pequenas quando comparadas aos esforços iniciais introduzidos pelos aparelhos de protensão. Desse modo, as armaduras de protensão exercem um papel ativo na distribuição dos esforços internos nas peças estruturais onde estão inseridas, por isso, são chamadas de armaduras ativas. A Figura 1-1 apresenta a seção transversal de uma viga de concreto armado submetida à flexão, destacando-se as porções da seção transversal que estão sujeitas à compressão e à tração.
According to previous studies, bacterial infection plays the most important role in the late fail... more According to previous studies, bacterial infection plays the most important role in the late failures of dental implants. Peri-implantitis has been described as a site-specific infection that causes soft tissue inflammation and bone loss around osseointegrated implants that have performed masticatory functions. To reduce the number of pathogenic species and improve the clinical parameters (that is, probing depth, bleeding on probing, and suppuration) around dental implants, several anti-infective therapies have been developed for peri-implantitis. However, recent reviews have not identified sufficient evidence to support an ideal anti-infective protocol for this disease. This article presents a case of advanced peri-implantitis that was treated with a single surgical anti-infective mechanical therapy. A follow-up visit 12 months post-treatment showed improved clinical features.
The influence of diabetes mellitus (DM) on the hemodynamics of periodontal tissues has not been a... more The influence of diabetes mellitus (DM) on the hemodynamics of periodontal tissues has not been assessed previously. The primary objective of this study was to validate optical spectroscopy as a periodontal diagnostic tool for subjects with type 2 DM and chronic periodontitis. Using a portable optical near-infrared spectrometer, optical spectra were obtained from healthy (n = 127), gingivitis (n = 115), and periodontitis (n = 109) sites of 65 subjects with type 2 DM and chronic periodontitis. Healthy (n = 65) sites of 15 nondiabetic subjects without periodontitis were used as controls. A modified Beer-Lambert unmixing model that incorporates a nonparametric scattering-loss function was used to determine the relative contribution of deoxygenated hemoglobin and oxygenated hemoglobin (HbO2 ) to the overall spectrum. The balance between tissue oxygen delivery and oxygen utilization in periodontal tissues was assessed. In diabetic subjects, tissue oxygen saturation and HbO2 concentration were significantly decreased in the periodontitis sites (p < 0.01) compared with the healthy and gingivitis sites. Furthermore, tissue oxygenation in healthy sites of control subjects was significantly higher than that in sites of diabetic subjects (p < 0.01). In summary, the results of this study suggest that optical spectroscopy can monitor the hemodynamic profile in diabetic subjects with chronic periodontitis. Furthermore, healthy sites of diabetic subjects presented lower tissue oxygenation than did those of nondiabetic subjects.
Background: This 6-month study evaluated the effects of resin-modified glass-ionomer cement (RMGI... more Background: This 6-month study evaluated the effects of resin-modified glass-ionomer cement (RMGI) and microfilled composite (MC) subgingival restorations on periodontal tissues and subgingival biofilm.
We have recently developed a periodontal diagnostic tool that was validated in non-smokers with p... more We have recently developed a periodontal diagnostic tool that was validated in non-smokers with periodontitis. Tobacco smoking is a recognized risk factor for periodontal diseases that can mask gingival bleeding and lead to a false negative diagnosis. Therefore, the purpose of current study is to further validate this instrument in smokers with periodontal diseases. Using a portable optical near-infrared spectrometer, optical spectra were obtained, processed and evaluated from healthy (n = 108), gingivitis (n = 100), and periodontitis (n = 79) sites of 54 systemically healthy smokers. A modified Beer-Lambert unmixing model that incorporates a non-parametric scattering loss function was used to determine the relative contribution of deoxygenated haemoglobin (Hb) and oxygenated haemoglobin (HbO2 ) to the overall spectrum. The balance between tissue oxygen delivery and utilization in periodontal tissues was then assessed. Tissue oxygen saturation was significantly decreased in the gingivitis (p = 0.016) and periodontitis (p = 0.007) sites, compared to the healthy sites. There was a trend towards increased concentration of Hb and decreased concentration of HbO2 from healthy to diseased sites, without statistical significance (p > 0.05). Optical spectroscopy can determine tissue oxygenation profiles of healthy and diseased sites in smokers. The spectral profile of periodontal sites in smokers generally resembles those from non-smoking patients.
The aim of this randomized controlled clinical trial was to evaluate the clinical effects of chlo... more The aim of this randomized controlled clinical trial was to evaluate the clinical effects of chlorhexidine (CHX) application in a full-mouth disinfection (FMD) protocol in poorly controlled type-2 diabetic subjects with generalized chronic periodontitis. Thirty-eight subjects were randomly assigned into FMD group (n=19): full-mouth scaling and root planing (FMSRP) within 24 h + local application of CHX gel + CHX rinses for 60 days or Control group (n = 19): FMSRP within 24 h + local application of placebo gel + placebo rinses for 60 days. Clinical parameters, glycated haemoglobin and fasting plasma glucose were assessed at baseline, 3, 6 and 12 months post-therapies. All clinical parameters improved significantly at 3, 6 and 12 months post-therapies for both groups (p < 0.05). There were no significant differences between groups for any clinical parameters, and glycemic condition at any time-point (p > 0.05). The treatments did not differ with respect to clinical parameters, including the primary outcome variable (i.e. changes in clinical attachment level in deep pockets), for up to 12 months post-treatments.
Objectives: The aim of this study was to evaluate the clinical and microbiological effects of mec... more Objectives: The aim of this study was to evaluate the clinical and microbiological effects of mechanical anti-infective therapies for mucositis and peri-implantitis.
The aim of the present case series was to evaluate the effects of a surgical anti-infective mecha... more The aim of the present case series was to evaluate the effects of a surgical anti-infective mechanical therapy for peri-implantitis on clinical parameters and tumor necrosis factor-alpha (TNF-alpha) levels at 12 months post-therapy. Ten patients with peri-implantitis were treated with open surgical debridement, abrasive sodium carbonate air-powder, and resin curets. Clinical parameters were recorded before and 3 and 12 months after therapy. At these time points, the total amounts of TNF-alpha in the peri-implant crevicular fluid were measured by enzyme-linked immunosorbent assay. At 3 and 12 months, the anti-infective therapy resulted in significant improvements in all clinical parameters (P <0.05). Moreover, the total amount of TNF-alpha was significantly reduced at 3 and 12 months after therapy compared to baseline (P <0.05), paralleling the changes in mean probing depth and bleeding on probing. The anti-infective mechanical therapy reduced the crevicular levels of TNF-alpha in sites affected by peri-implantitis over a period of 12 months, and this phenomenon was associated with improvements in clinical parameters.
Background: This study evaluated the clinical and metabolic effects of full-mouth scaling and roo... more Background: This study evaluated the clinical and metabolic effects of full-mouth scaling and root planing (FMSRP) compared to partial-mouth scaling and root planing (PMSRP) in patients with type 2 diabetes and chronic periodontitis, and it assessed the impact of the glycemic status on the clinical and metabolic response to periodontal therapy.
Objective: This study assessed gene expression by quantitative polymerase chain reaction of infla... more Objective: This study assessed gene expression by quantitative polymerase chain reaction of inflammatory-[interleukin (IL)-12, tumor necrosis factor-a (TNF-a), IL-4, and IL-10] and osteoclastogenesis-related factors [receptor activator of NF-kB ligand (RANKL) and osteoprotegerin (OPG)] in sites exhibiting different severities of peri-implant disease.
The objectives of this study were to clinically and immunologically assess the effects of mechani... more The objectives of this study were to clinically and immunologically assess the effects of mechanical anti-infective therapies for mucositis and peri-implantitis and to compare the levels of cytokines in untreated and treated peri-implant diseased sites to healthy ones. Titanium dental implants were assigned to one of the following groups: healthy (n = 10) = control; mucositis (n = 10) = mechanical debridement using abrasive sodium carbonate air-powder and resin curets; and peri-implantitis (n = 20) = open surgical debridement using abrasive sodium carbonate air-powder and resin curets. Visible plaque accumulation, marginal bleeding, bleeding on probing, suppuration, and probing depth were assessed at baseline for all groups and at 3 months after therapies for diseased groups. At these times, the total amounts of interleukin (IL)-4, -10, and -12, tumor necrosis factor-alpha (TNF-alpha), receptor activator of nuclear factor-kappa B ligand (RANKL), and osteoprotegerin (OPG) in the peri-implant crevicular fluid (PICF) were measured by enzyme-linked immunosorbent assay. At 3 months, the anti-infective treatments resulted in a significant improvement in all clinical parameters for mucositis and peri-implantitis (P <0.05). Moreover, the total amounts of TNF-alpha in PICF were significantly higher in untreated diseased implants compared to healthy ones, and the OPG/RANKL ratio was higher for healthy implants than for untreated peri-implantitis (P <0.05). TNF-alpha levels were significantly reduced for both diseased groups (P <0.05), achieving the same level as the healthy group at 3 months after therapies (P >0.05). The proposed anti-infective therapies may locally modulate the levels of TNF-alpha and the OPG/RANKL ratio and improve clinical parameters around peri-implant tissues.
PM: Cytokine levels in sites of chronic periodontitis of poorly controlled and well-controlled ty... more PM: Cytokine levels in sites of chronic periodontitis of poorly controlled and well-controlled type 2 diabetic subjects.
Rationale: Although recent studies have suggested a role for the receptor activator of nuclear fa... more Rationale: Although recent studies have suggested a role for the receptor activator of nuclear factor B ligand (RANKL) in the late stages of atherosclerosis (eg, plaque destabilization and rupture), the underlying mechanisms and subsequent events are unclear.
A história do material mais utilizado na construção civil I In nt tr ro od du uç çã ão o a ao o C... more A história do material mais utilizado na construção civil I In nt tr ro od du uç çã ão o a ao o C Co on nc cr re et to o A Ar rm ma ad do o Então, a partir deste momento, os esforços de tração passam a ser absorvidos pelas armaduras de aço. Nas estruturas de concreto armado, os esforços atuantes nas armaduras são decorrentes das ações aplicadas à superfície externa da estrutura após a sua construção. Isso significa que as tensões e deformações que surgem nas armaduras são exclusivamente decorrentes do carregamento externo à peça onde elas estão inseridas. Portanto, as armaduras são solicitadas em consequência das deformações do concreto da própria estrutura. Assim, as armaduras acompanham passivamente as deformações da estrutura, por isso, no concreto armado elas são chamadas de armaduras passivas. Quando o concreto endurece, formado a peça estrutural, o concreto e suas armaduras passam a trabalhar solidariamente, isto é, não existe escorregamento relativo entre os dois materiais. Esta é a hipótese fundamental da teoria do concreto armado. No concreto protendido, utilizando dispositivos adequados, as armaduras de protensão são tracionadas durante a construção da estrutura, armazenando tensões residuais permanentes. Embora as armaduras de protensão também tenham seus esforços alterados pelo carregamento externo à peça onde elas estão inseridas, essas alterações são relativamente pequenas quando comparadas aos esforços iniciais introduzidos pelos aparelhos de protensão. Desse modo, as armaduras de protensão exercem um papel ativo na distribuição dos esforços internos nas peças estruturais onde estão inseridas, por isso, são chamadas de armaduras ativas. A Figura 1-1 apresenta a seção transversal de uma viga de concreto armado submetida à flexão, destacando-se as porções da seção transversal que estão sujeitas à compressão e à tração.
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