Pacientes com câncer de mama sob quimioterapia tem níveis aumentados de marcadores inflamatórios, que podem piorar condições periodontais pré-existentes. Este estudo avaliou o efeito do tratamento periodontal nao cirúrgico (TPNC) e estabeleceu a correlação entre os parâmetros clínicos com os níveis de citocinas presentes no fluido crevicular gengival (FCG) antes e após TPNC. Quarenta indivíduos foram alocados em dois grupos; pacientes com periodontite cronica (PC) (n=20) e pacientes com câncer de mama com periodontite crônica (CAN/PC) (n=20). Os seguintes parâmetros clínicos e imunológicos foram analisados: i) profundidade de sondagem (PS), nível clinico de inserção (NCI), índice gengival (IG), índice de placa (IP), ii) avaliação dos níveis de Interleucina (IL) - 4, IL-10, IL-17, IL-2, IL-6, IL-1&beta;, Interferon gama (INF-&gamma;), Fator de Necrose Tumoral alfa (TNF-&alpha;) e Fator de Crescimento Tumoral-beta (TGF-&beta;) no fluido crevicular gengival (Luminex), no baseline, 45 dias e 180 dias após TPNC. Os dados obtidos foram estatisticamente analisados. Nas comparações entre grupos: No baseline, o grupo PC apresentou níveis maiores de INF-&gamma; e níveis menores de IL- 10 e TGF-&beta; quando comparados ao grupo CAN/PC. Aos 45 dias o grupo CAN/PC apresentou níveis mais reduzidos de TNF-&alpha; (p < 0,0001) em comparação com o grupo PC. Em relação aos 180 dias, o grupo PC apresentou níveis mais reduzidos de INF-&gamma; (p < 0,001), IL-2 (p < 0. 001), TNF-&alpha; (p < 0,0001) e níveis elevados de IL-10 (p < 0,01) e TGF-&beta; (p < 0,001), quando comparados ao grupo CAN/PC. Nas comparações entre períodos de tempo: o grupo CAN/PC apresentou uma redução significativa de IL-2 aos 45 e 180 dias (p < 0,05) em comparação com baseline, TNF-&alpha; teve uma redução aos 45 dias, em comparação com baseline (p < 0.0001), alem disso, houve uma redução significativa do TGF-&beta; aos 180 dias em comparação com baseline (p < 0,0001). Enquanto IL-1&beta;, foi aumentado aos 45 dias em comparação com baseline (p < 0,05). No grupo PC, houve uma redução significativa dos níveis de INF-&gama; aos 180 dias, em comparação com baseline (p < 0,0001) e 45 dias (p < 0,05). Da mesma forma, IL-2 e TNF-&alpha; reduziram aos 180 dias, em comparação com baseline (p < 0,0001) e 45 dias (p < 0,0001), bem como um aumento de TGF-&beta; aos 180 dias, em comparação com baseline (p < 0,05) e 45 dias (p < 0,0001). Na análise de correlação entre os parâmetros clínicos e os níveis de citocinas do FCG: No grupo CAN/PC, foi encontrado uma positiva correlação entre PS e os níveis de TNF-&alpha; (r = 0.6489, p = 0.002) no baseline. IL-17 foi positivamente correlacionado com redução de PS (r = 0.4596, p = 0.04) aos 180 dias; assim também IL-6 foi positivamente correlacionado com redução de PS e ganho de NCI (r = 0.4513, p = 0.05, r = 0.5578, p = 0.01, respectivamente) aos 180 dias. No grupo PC, IL-17 foi positivamente correlacionada com PS e NCI (r = 0.4558, p = 0.04, r= 0.5447, p = 0.01, respectivamente) no baseline. IL-1&beta; foi positivamente correlacionado com redução de PS e ganho de NCI (r = 0.5538, p = 0.01, r = 0.5902, p = 0.006, respectivamente), aos 45 dias. Uma negativa correlação foi encontrada entre IL-4 e ganho de NCI (r = -0.4981, p = 0.03) aos 180 dias. Pode-se concluir que a TPNC reduz os estímulos antigênicos e consequentemente ajuda a reduzir a carga inflamatória de pacientes com câncer de mama com periodontite crônica, melhorando assim as condições clinicas periodontais e sistêmicas. / Patients with breast cancer undergoing chemotherapy have increased levels of inflammatory markers, which may worsen pre-existing periodontal conditions. The aim of this study was to evaluate the effect of non-surgical periodontal treatment (NSPT) and to establish a correlation between clinical parameters and levels of cytokines present in the gingival crevicular fluid (GCF) before and after NSPT. Forty individuals were allocated in two groups; patients with chronic periodontitis (PC) (n = 20) and patients with breast cancer with chronic periodontitis (CAN/PC) (n = 20). The following clinical and immunological parameters were analyzed: i) probing depth (PD), clinical attachment level (CAL), gingival index (GI), plaque index (PI), ii) levels of Interleukin (IL) - 4, IL-10, IL-17, IL-2, IL-6, IL-1&beta;, Interferon gamma (INF-&gama;), tumor necrosis factor (TNF-&alpha;), transforming growth factor beta (TGF-&beta;) in gingival crevicular fluid (Luminex) in baseline, 45 days and 180 days after NSPT. The data were statistically analyzed. In the comparisons between groups: At the baseline, the PC group had higher levels of INF-&gama; and low levels of IL-10 and TGF-&beta; when compared to the CAN/PC group. At 45 days, the CAN/PC group had lower levels of TNF&alpha;- (p <0.0001) compared to the PC group. In 180 days, the PC group had lower levels of INF-&gama; (p <0.001), IL-2 (p < 0. 001), TNF-&alpha; (p <0.0001), and higher levels of IL-10 (p < 0.01) and TGF-&beta; (p < 0.001), compared to the CAN/PC group. In comparisons between periods: The CAN/PC group showed a significant reduction of IL-2 at 45 and 180 days (p < 0.05) compared to baseline, TNF-&alpha; had a reduction at 45 days, when compared to baseline (p < 0.0001). In addition, there was a significant reduction of TGF-&beta; at 180 days when compared to the baseline (p < 0.0001), while IL-1&beta; increased at 45 days when compared to baseline (p < 0.05). The P group showed a significant reduction of INF-&gama; at 180 days when compared to baseline (p < 0.0001) and 45 days, (p <0.05). In the same manner, IL-2 and TNF-&alpha; had a reduction at 180 days when compared to baseline (p < 0.0001) and 45 days (p <0.0001). Likewise, there was an increase of TGF-&beta; at 180 days when compared to the baseline (p < 0.05) and at 45 days (p <0.0001). IL-17, IL-6 and IL-4 had no statistically significant differences between groups in all time points. In the analysis of correlation between the clinical parameters and the cytokine levels of the GCF: In the CAN/P group, a significant positive correlation was found between PD and TNF-&alpha; levels (r = 0.6489, p = 0.002) at baseline. IL-17 was positively correlated with PD reduction (r=0.4596, p = 0.04) at 180 days; also IL-6 was significantly positively correlated with PD reduction and CAL gain (r = 0.4513, p = 0.05, r = 0.5578, p = 0.01, respectively) at 180 days. In the P group, IL-17 was also positively correlated with PD and CAL (r = 0.4558, p = 0.04, r = 0.5447, p = 0.01, respectively) at baseline. IL-1&beta; was positively correlated with PD reduction and CAL gain (r = 0.5538, p = 0.01, r = 0.5902, p = 0.006, respectively) at 45 days. A negative correlation was found between IL-4 and CAL gain (r = -0.4981, p = 0.03) at 180 days. In conclusion, these data suggest that NSPT reduces antigenic stimuli and consequently helps to reduce the inflammatory burden in breast cancer patients with chronic periodontitis.

Ziel dieser Studie war es, Auswirkungen von subgingival applizierter Hyaluronsäure (Gengigel®) nach scaling and root planing (SRP) auf mikrobiologische Variablen bei Parodontitispatienten nachzuweisen. Dabei wurden die möglichen Zusammenhänge zwischen Ergebnissen der Bakterienspezies und zuvor ermittelten Ergebnissen klinischer Variablen untersucht. An der Untersuchung nahmen 20 Männer und 29 Frauen teil. Es erfolgte eine Randomisierung in zwei Gruppen, bestehend aus einer Testgruppe mit 23 und einer Kontrollgruppe mit 26 Probanden. Bei den Versuchteilnehmern wurde in zwei Sitzungen in einem 24-stündigen Abstand ein SRP mittels Hand- und Ultraschallinstrumenten durchgeführt. Am Ende des SRP wurde in der Testgruppe Gengigel prof® (mit 0,8% Hyaluronsäure) in die parodontalen Taschen eingebracht. Zusätzlich trugen die Probanden der Testgruppe während der folgenden 14 Tage zweimal täglich morgens und abends Gengigel® (0,2%) auf den Gingivarand auf. In der Kontrollgruppe erfolgte das übliche SRP ohne Verwendung von Gengigel®. Alle Probanden wurden zu Beginn der Untersuchung, nach drei und sechs Monaten aus parodontologischer Sicht untersucht. Des Weiteren wurden Proben der Sulkusflüssigkeit für eine spätere Analyse von zehn parodontopathogenen Keimen sowie der Peroxidase- und Granulozytenaktivität gewonnen. Im Gegensatz zur kontinuierlichen Zunahme in der Kontrollgruppe (p=0,035) konnte beim Verlauf der Gesamtbakterienzahl für die Testgruppe keine Veränderung der Keimzahlen (p=0,737) beobachtet werden. In der Testgruppe wurde nach sechs Monaten für Campylobacter rectus, Treponema denticola und Aggregatibacter actinomycetemcomitans eine Reduktion der Keimbelastung festgestellt (p=0,05; p=0,043; p=0,066). Am Ende der Untersuchung waren in der Testgruppe keine Unterschiede in der bakteriellen Besiedlung unterschiedlich tiefer Taschen mehr nachweisbar (p=1). In der Testgruppe bestand eine stark signifikante Korrelation der Granulozytenaktivität mit der Zeit (r=0,443; p<0,0001) und mit der Gesamtbakterienzahl (r=0,336; p=0,009). Die Ergebnisse der Studie weisen auf einen wachstumshemmenden Effekt der Hyaluronsäure auf parodontopathogene Bakterien hin, welcher womöglich auf einer indirekten Interaktion mit dem Immunsystem basiert.

Background: Hitherto no study has been published on the effect of the adjunctive administration of essential oils following scaling and root planing (SRP). This study describes the effect of a mouthrinse consisting of essential oils (Cymbopogon flexuosus, Thymus zygis and Rosmarinus officinalis) following SRP by clinical and microbiological variables in patients with generalized moderate chronic periodontitis. Methods: Forty-six patients (aged 40–65 years) with moderate chronic periodontitis were randomized in a double-blind study and rinsed their oral cavity following SRP with an essential oil mouthrinse (n = 23) or placebo (n = 23) for 14 days. Probing depth (PD), attachment level (AL), bleeding on probing (BOP) and modified sulcus bleeding index (SBI) were recorded at baseline and after 3 and 6 months. Subgingival plaque was taken for assessment of major bacteria associated with periodontitis. Results: AL, PD, BOP and SBI were significantly improved in both groups after three (p < 0.001) and 6 months (p ≤ 0.015). AL improved significantly better in the test than in the control group after 3 and 6 months (p < 0.001), so did PD after three months in the tendency (p = 0.1). BOP improved better in the test group after 3 months (p = 0.065). Numbers of Treponema denticola (p = 0.044) and Fusobacterium nucleatum (p = 0.029) decreased more in the test than in the control group after 3 months, those of Tannerella forsythia after 6 months (p = 0.039). Prevotella micra (p < 0.001,p = 0.035) and Campylobacter rectus (p = 0.002,p = 0.012) decreased significantly in both groups after 3 months. Conclusions: The adjunctive use of a mouthrinse containing essential oils following SRP has a positive effect on clinical variables and on bacterial levels in the subgingival biofilm.

Abstract OBJECTIVES: The objective of the present study is to compare the effect of systemic adjunctive use of azithromycin with amoxicillin/metronidazole to scaling and root planing (SRP) in a clinical study. MATERIALS AND METHODS: Data from 60 individuals with chronic periodontitis were evaluated after full-mouth SRP. Antibiotics were given from the first day of SRP, in the test group (n = 29), azithromycin for 3 days and, in the control group (n = 31), amoxicillin/metronidazole for7 days. Probing depth (PD), attachment level (AL), and bleeding on probing (BOP) were recorded at baseline and after 3 and 12 months. Gingival crevicular fluid was analyzed for matrix metalloprotease (MMP)-8 and interleukin (IL)-1beta levels. Subgingival plaque was taken for assessment of the major bacteria associated with periodontitis. RESULTS: In both groups, PD, AL, and BOP were significantly reduced (p < 0.001). A few significant differences between the groups were found; AL and BOP were significantly better in the test than in the control group at the end of the study (p = 0.020 and 0.009). Periodontopathogens were reduced most in the test group. CONCLUSIONS: A noninferiority of the treatment with azithromycin in comparison with amoxicillin/metronidazole can be stated. The administration of azithromycin could be an alternative to the use of amoxicillin/metronidazole adjunctive to SRP in patients with moderate or severe chronic periodontitis; however, a randomized placebo-controlled multicenter study is needed. CLINICAL RELEVANCE: Application of azithromycin as a single antibiotic for 3 days might be considered as an additional adjunctive antibiotic to SRP in selected patients.:Inhaltsverzeichnis 1 Einleitung 7 1.1 Klassifikation der Parodontitiden 7 1.2 Prävalenz der Parodontitis 8 1.3 Parodontales Erregerspektrum 9 2 Aufgabenstellung 12 3 Material und Methode 13 3.1 Erhobene Variablen 15 3.2 Therapie und Nachbehandlung 20 3.3 Biochemische und mikrobiologische Analyse 21 3.3.1 Probenentnahme 21 3.3.2 Analyse 22 3.4 Statistische Auswertung 23 4 Ergebnisse 25 5 Diskussion 33 6 Zusammenfassung 40 7 Literaturverzeichnis 44 8 Anhang 61 9 Publikation 65 10 Lebenslauf 66 11 Danksagung 67 12 Erklärung über die eigenständige Abfassung der Arbeit 68

In this scientific work was performed the extended study of hypersensitive teeth on patients with chronic periodontitis in order to evaluate the frequency of this painful condition and the intensity of provoked pain, its dependency on individual′s age, sex, nutrition and oral hygiene habits, extent of tooth mobility and dental attachment loss, amount of the plaque on tooth surfaces, professional oral hygiene, surgical treatment of chronic periodontitis; to examine the structure of dental pulp and hard tissue of hypersensitive teeth, to assess the effectiveness and possibility of treatment using a new generation desensitizing materials. It was determined that the prevalence of teeth hypersensitivity and the pain intensity among the patients with chronic periodontitis is high and directly dependent on individual′s nutrition, oral hygiene habits, age, the extent of tooth mobility and dental attachment loss; professional oral hygiene and surgical treatment significantly increases the pain intensity of hypersensitive teeth; were not found any structural changes in the pulp, hard tissues and myelinated nerve fibres of hypersensitive teeth; new generation desensitizing materials ensure fast, effective and long-lasting reduction of pain intensity.