Indiana University-Purdue University Indianapolis (IUPUI) / The purpose of this investigation was to study the incidence of enamel pitting and gingival fibromas in patients with tuberous sclerosis complex (TSC) and relate these findings to other physical findings of TSC, to sporadic and familial disease, and to specific TSC2 mutations. Methods: A total of 104 patients between 1 and 51 years of age were examined for enamel pits and gingival fibromas. All study subjects had a definitive diagnosis of TSC and were participants in a related study that provided results from MRI scans of the brain, echocardiography, renal ultrasound, neuropsychological assessments, and retinal examinations. Blood samples were obtained from each participant for DNA extraction and subsequent TSC mutational analysis. Results: Enamel pitting was seen in 29% of patients between 1 and 6 years of age, in 90% between 6 and 13 years of age, and in 100% of patients in the permanent 113 dentition. The majority of the pits were pinpoint sized and primarily affected the maxillary anterior arch. The maxillary central incisor was the most often affected permanent tooth and the maxillary canine was the most often affected primary tooth. Gingival fibromas were apparent in 47% of subjects in the mixed dentition and in 70% of subjects in the permanent dentition. Only one patient out of 31 in the primary dentition had a gingival fibroma. The majority of fibromas affected the interdental papilla of the maxillary anterior arch. There were few significant findings relating the degree and/or severity of enamel pitting and/or gingival fibromas to other physical findings of TSC. Enamel pitting in primary as well as permanent teeth were found to be strongly related to the presence of facial angiofibromas and a somewhat weaker association was seen with cardiac arrhythmias. Gingival fibromas were strongly related to the presence of facial angiofibromas and more weakly related to retinal lesions. There were no distinctions apparent between oral findings in sporadic and familial TSC nor were there any genotype-phenotype correlations between oral findings and TSC2 mutations. Conclusion: The combination of enamel pitting and gingival fibromas, as minor features of TSC, should raise the suspicion level regarding tuberous sclerosis as a diagnosis. Both are important minor features frequently seen which may help in establishing a definitive diagnosis. Scanning the dentition and gingiva is noninvasive, is inexpensive, and should be included in evaluating all patients suspect of a diagnosis of tuberous sclerosis.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-02-14T13:32:22Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertacao LUANA OSÓRIO FERNANDES.pdf: 1894600 bytes, checksum: 262777160a929e18e667f73cb8233ae7 (MD5) / Made available in DSpace on 2017-02-14T13:32:22Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertacao LUANA OSÓRIO FERNANDES.pdf: 1894600 bytes, checksum: 262777160a929e18e667f73cb8233ae7 (MD5) Previous issue date: 2015-02-11 / Este estudo avaliouo desempenho daTomografia de Coerência Ópticaem1325nmcomoum método não invasivopara medir a profundidadedo sulco gengivalde indivíduossaudáveisem comparação comsondasperiodontaistradicionais emumambiente clínico.Dois observadoresavaliaram aprofundidade dosulco gengivalde 445sitios emdentes anteriores, tanto superior einferior,de 23 indivíduos saudáveis, por meio de três ferramentas: sonda periodontal Carolinado Norte (NC), sonda computadorizadaFloridaProbe (FP)eTomografia por Coerência Óptica(OCT). Foi obtido oíndice de refraçãogengival,necessário para correção dos valores obtidos por OCT,a partir da análisede19 amostras provenientes de cirurgia periodontal. Para cada técnica, foiregistradoo grau de desconforto/dor, através da escala verbal de 4 pontos(VRS-4) e Escala Numérica da Dor (END), e o tempo com auxílio de cronômetro digital.As imagens de OCT mostraramestruturas anatômicasclinicamente relevantes do ponto de vista periodontalnaáreaavaliada.O valor médiocalculadopara o índicede refraçãoda gengivafoi de 1,41±0,06, dado utilizado para realizar a correção dos valores obtidos pelo OCT, através de regra de três simples.As imagens de OCT proporcionaram analisar o correspondente ao sulco gengivalhistológicocom valor médiode 0,86±0,27 milímetros.A sondaNCresultou em maiores valores de profundidade(1,43 ±0,56 milímetros), seguido pelaFP(1,25±0,58 milímetros) que proporcionou umamaior frequência dedesconforto edor.O tempo registrado para cada técnica foi maior para o OCT (19,61±8,98 minutos) decorrente do caráter laboratorial do equipamento, seguido da FP (2,44±1,04 minutos) e NC (1,77±0,40 minutos), ambas adaptadas para aplicação clínica.Diante dos resultados, pode-se concluir que o OCTéummétodo promissorparaa análise in vivodasaúde periodontal, permitindoo diagnósticoprecoce e preciso, de maneiranão invasiva, e que sua influência e interferênciasobre a avaliaçãoclínicaéinexistente, diferente dousodeumasonda periodontal.Porém, ainda se faz necessário a adaptação do equipamento para utilização na clinica odontológica. / This study evaluatedthe performance ofOpticalCoherenceTomographyin 1325nmas a noninvasivemethodto measure the depthof the gingival sulcusof healthysubjects compared totraditionalperiodontalprobesin a clinical setting.Twoobservers evaluatedthe depth of thegingival sulcusof 445sitesin anterior teeth, both top and bottomof 23individuals, using threetools: periodontal probeNorth Carolina (NC), electronic probeFloridaProbe (FP) and Optical CoherenceTomography(OCT). Was obtainedgingivalindex of refractionneeded tocorrect thevalues obtained byOCT,from the analysisof 19samples fromperiodontalsurgery. For eachtechnique,the degree of discomfort/painwas recordedbyverbal4-point scale(VRS-4) and NumericalPainScale (NPS), andtimeusing a digitalstopwatch.The OCTimages showedclinically relevantanatomical structures of theperiodontalviewpoint in thearea evaluated.Theaverage value calculated forthegumrefractive indexwas 1.41± 0.06, as used to perform thecorrection of values obtainedbyOCT,throughsimple rule of three.TheOCTimagesprovidedanalyze thehistologicalsulcuscorresponding toan average valueof 0.86±0.27 mm.The CNproberesulted in greaterdepth values(1.43± 0.56millimeters), followed by FP(1.25±0.58 mm) which gavea higher frequency ofdiscomfort and pain.Thetime recordedfor each techniquewas higher fortheOCT(19.61 ±8.98 minutes) due to thecharacter oflaboratoryequipment, followed by FP(2.44±1.04 minutes) andNC (1.77 ±0, 40 minutes), bothadaptedfor clinical application. With the results, we can concludethatOCTis apromising method forin vivoanalysisof periodontalhealth, enabling early and accurate diagnosis, noninvasively, andthat its influenceandinterferenceon clinical evaluationis lacking,differentthe use ofa periodontalprobe.However,the upgrading of equipmentis still neededfor usein the dentalclinic.

Uma faixa adequada de mucosa ceratinizada (MC) é importante para garantir condições mínimas necessárias para o estabelecimento da homeostasia do periodonto de proteção. Frente à infecção bacteriana, os tecidos periodontais e peri-implantares desenvolvem uma resposta imune inflamatória local, resultando na produção e liberação de diversos mediadores inflamatórios que podem ser encontrados no fluido do sulco gengival e peri-implantar. Entretanto, é escassa a literatura acerca dos níveis desses mediadores em sítios peri-implantares considerando a faixa de MC. Assim, o objetivo deste trabalho foi avaliar a associação entre a quantidade e qualidade da MC peri-implantar e parâmetros clínicos e a qualidade da resposta imune através da análise da concentração de mediadores inflamatórios (IL-1, IL-4, IL-6, IL-8, MIP-1, TNF- e VEGF) presentes no fluido peri-implantar humano antes (T1) e depois (T2) da raspagem subgengival, através de imunoensaio. Parâmetros clínicos avaliaram índice de placa (IP), supuração a sondagem (S), profundidade de sondagem (mesial-PSM, centro-PSC e distal-PSD), índice de sangramento (mesial-ISM, centro-ISC e distal-ISD), nível de inserção relativo (NIR), largura (LMC) e espessura (EMC) da MC na face vestibular. Amostras de fluido sulcular foram coletadas e analisadas. Os implantes foram divididos em grupos de acordo com a faixa de MC (G12mm e G2>2mm) e espessura de MC (GA11mm e GB1>1mm; GA21,5mm e GB2>1,5mm). Foram avaliados 20 pacientes (11 homens e 9 mulheres) com idade entre 40 e 80 anos (53,45±10,32), que apresentaram 42 implantes (G1=25 e G2=17). Os resultados clínicos demonstraram diferença estatística significativa apenas entre T1 e T2 dentro do G1 para IP (T1=56% e T2=16%) e ISM (T1=68% e T2=40%). Foi observada diferença estatística entre G1 e G2 apenas para IL-1 em T2 (G1=9,77pg/ml±12,44 e G2=30,13pg/ml±32,29). Intra-grupos, todas as citocinas aumentaram significativamente, mas apenas no G2, demonstrando diferença de reatividade entre grupos. Quanto à espessura da MC (GA1=6 e GB1=36), resultados clínicos revelaram diferença inter-grupos para ISC em T2 (GA1=16,67% e GB1=61,11%) e intra-grupos para IP no GB1 (T1=52,78% e T2=27,78%). Houve aumento significativo no GB1 para todas as citocinas, exceto VEGF, assim como para IL-1 no GA1. Quando a amostra foi redistribuída em GA2=24 e GB2=18, os resultados clínicos indicaram diferença estatística inter-grupos para PSC em T2 (GA2=2,58mm±1,06 e GB2=3,11mm±1,02) e intra-grupos para IP (T1=62,5% e T2=20,83%) e PSC (T1=2,92mm±1,18 e T2=2,58mm±1,06) no GA2 e para ISM (T1=55,56% e T2=27,78%) no GB2. Intra-grupos observou-se aumento significativo para todas as citocinas no GA2 exceto VEGF, assim como IL-8 no GB2. Conclui-se que as diferenças clínicas apresentadas tenderam a evidenciar a importância da MC principalmente após o preparo inicial e, além disso, uma faixa de MC maior que 2mm influenciou os níveis dos mediadores inflamatórios avaliados após a raspagem subgengival. Adicionalmente, a falta de diferença estatística significativa na comparação entre grupos com diferentes espessuras de MC, bem como tal diferença ora no grupo espesso ora no grupo fino quando se adotam diferentes valores de corte (1mm ou 1,5mm respectivamente), demonstra resultados inconclusivos, ressaltando a importância de novas pesquisas para responder esta questão. / An adequate keratinized mucosa (KM) width is important to ensure minimal conditions necessary to establish protect periodontium homeostasis. When a bacterial infection occurs, periodontal and peri-implant tissues develop a local inflammatory immune response that results in production and release of several inflammatory mediators that may be found in gingival crevicular and in peri-implant fluids. However, there is a lack of literature concerning about the levels of these mediators in peri-implant sites considering KM width. The aim of this study was to evaluate the association between KM peri-implant quantity and quality and clinical parameters and immune response quality by analyzing the inflammatory mediators concentration (IL-1, IL-4, IL-6, IL-8, MIP-1, TNF- and VEGF) present in human peri-implant fluid before (T1) and after (T2) subgingival scaling, by immunoassay. Clinical parameters evaluated plate index (PI), probing suppuration (S), probing depth (mesial-PDM, center-PDC and distal-PDD), bleeding index (mesial-BIM, center-BIC and distal-BID), relative attachment level (RAL), keratinized mucosa width (KMW) and thickness (KMT) on the buccal face. Sulcular fluid samples were collected and analyzed. The implants were divided in groups according KM width (G12mm and G2>2mm) and KM thickness (GA11mm and GB1>1mm, GA21,5mm and GB2>1,5mm). Twenty patients (11 men and 9 women) aged 40 to 80 years (53,45±10,32) were evaluated, with 42 implants (G1=25 and G2=17). Clinical results showed a significant statistical difference only between T1 and T2 within G1 for PI (T1=56% and T2=16%) and BIM (T1=68% and T2=40%). Statistical difference was observed between G1 and G2 only for IL-1 in T2 (G1=9,77pg/ml±12,44 and G2=30,13pg/ml±32,29). Intra-groups, all cytokines increased significantly, but only in G2, showing reactivity difference between groups. As to KM thickness (GA1=6 and GB1=36), clinical results revealed intergroup differences for BIC in T2 (GA1=16,67% and GB1=61,11%) and intra-groups for PI in GB1 (T1=52,78% and T2=27,78%). There was a significant increase in GB1 for all cytokines except VEGF, as well as for IL-1 in GA1. When the sample was redistributed in GA2=24 and GB2=18, clinical results indicated statistical inter-group differences for PDC in T2 (GA2=2,58mm±1,06 and GB2=3,11mm±1,02) and intra-groups for PI (T1=62,5% and T2=20,83%) and PDC (T1=2,92mm±1,18 and T2=2,58mm±1,06) in GA2 and for BIM (T1=55,56% and T2=27,78%) in GB2. Intra-groups were observed significantly increase for all cytokines in GA2 except VEGF, as well as IL-8 in GB2. Concluded that clinical differences presented tended to show the KM importance principally after the initial preparation and, in addition, KM width greater than 2mm influenced the inflammatory mediators levels evaluated after subgingival scaling. Additionally, the absence of significant statistic difference between groups when comparing the keratinized mucosa thickness, as well as this difference sometimes in the thick group or in the thin group when different court values was adopted (1mm or 1,5mm respectively), show inconclusive results, emphasizing the importance of new research that may answer this question.

As características microscópicas do tecido peri-implantar ao redor de diferentes tipos de interface protética para implantes foram avaliadas por meio de análise histológica, 10 pacientes portadores de prótese sobre implantes do tipo protocolo foram selecionados com base nos critérios de inclusão e divididos em dois grupos, com o grupo I formado por cinco pacientes portadores de implantes com interface do tipo hexágono externo e o grupo II formado por cinco pacientes com implantes com interface do tipo cone morse. Foram coletadas amostras de tecido gengival que estava em contato direto com o componente protético através de um procedimento cirúrgico, sendo coletada uma amostra de cada paciente, todas as amostras foram armazenadas em frascos contendo formalina a 10% e enviadas ao laboratório para a realização da análise. Na análise foram observados o grau de organização tecidual, presença e intensidade da inflamação e o grau de fibrosamento. As cinco amostras do grupo I apresentavam hiperplasia do epitélio, sendo todas classificadas como grau 2, todas mantinham sua integridade, sendo classificadas como preservadas, nenhuma das amostras deste grupo apresentavam ataque de células inflamatórias ao epitélio. Na análise do tecido conjuntivo, quatro amostras deste grupo apresentavam-se normais, sem a presença de inflamação, apenas uma das amostras apresentava sinais de inflamação, sendo a mesma classificada como moderada, todas as amostras apresentavam seu conjuntivo organizado, avaliando o grau de fibrosamento, duas amostras foram classificadas como grau 3, duas como grau 2 e uma amostra como grau 1, uma amostra deste grupo possuía fragmentos de cemento radicular envolto por fibras colágenas. No grupo II, quatro amostras apresentavam hiperplasia do epitélio, sendo classificadas como grau 2, apenas uma amostra encontrava-se livre de hiperplasia, quando foi avaliada a integridade do epitélio, três amostras foram classificadas como preservado e duas classificadas como desorganizadas,com a presença de células inflamatórias no interior do epitélio. Três amostras deste grupo apresentavam ataque de células inflamatórias ao epitélio. Na análise do tecido conjuntivo, todas as amostras foram classificadas como organizadas, com quatro das amostras apresentando sinais de inflamação, com intensidade classificada como grau 3 em duas amostras e como grau 2 em outras duas amostras, apenas uma amostra foi classificada livre de inflamação. Foram encontrados corpúsculos hialinos de Russel em três amostras. Avaliando o grau de fibrosamento, três amostras foram classificadas como grau 2 e duas como grau 3, foram encontrados fragmentos de cemento radicular em uma das amostras deste grupo. Na análise estatística não foram encontradas diferenças estatisticamente significantes para as variáveis hiperplasia, fibrosamento e intensidade da inflamação quando avaliadas separadamente, quando a interação das três variáveis foi avaliada, também não foram encontradas diferenças estatisticamente significantes, tendo os dois grupos apresentado resultados muito próximos. Com base nos resultados obtidos neste estudo, não foi possível afirmar que a presente metodologia permite estabelecer que um sistema de implante pode fornecer uma melhor condição ao tecido peri-implantar ao seu redor quando comparado ao outro sistema. / The microscopic characteristics of the peri-implant soft tissue around different types of prosthetic interface for implants has been evaluated by means of histological analysis, 10 patients carrying implant supported bridges has been selected on the basis of the inclusion criteria and divided in two groups, with group I formed by five patients with external hexagon interface type implants and group II formed by five patients with morse taper interface type implants. Gingival soft tissue samples that were in direct contact with prosthetic component have been collected through a surgical procedure, being a sample of each patient, all the samples had been stored in bottles containing 10% formaldehyde and sent to the laboratory for the accomplishment of the analysis. In the analysis, the degree of tissue organization, presence and intensity of the inflammation and the degree of fibrosity has been observed. The five samples of group I presented hyperplasia of the epithelium, being all classified as degree 2, all kept its integrity, being classified as preserved, none of the samples of this group presented attack of inflammatory cells to the epithelium. In the analysis of the connective tissue, four samples of this group were presented normal, without the inflammation presence, only one of the samples presented signals of inflammation, being classified as moderate one, all the samples presented its connective tissue organized, concerning the fibrosity degree, two samples had been classified as degree 3, two as degree 2 and a sample as degree 1, and a sample of this group possessed radicular cementum fragments wrapped by collagen fibers. In group II, four samples presented hyperplasia of the epithelium, being classified as degree 2, only one sample was free of hyperplasia, when the integrity of the epithelium was evaluated, three samples had been classified as preserved and two classified as disorganized, with the presence of inflammatory cells in the interior of the epithelium. Three samples of this group presented attack of inflammatory cells to the epithelium. In the analysis of the connective tissue, all the samples had been classified as organized, with four of the samples presenting signals of inflammation, with classified intensity as degree 3 in two samples and as degree 2 in others two samples, only one sample was classified free of inflammation. Russell\'s corpuscles have been found in three samples. Evaluating the fibrosity degree, three samples have been classified as degree 2 and two as degree 3, radicular cementum fragments were found in one sample of this group. In the statistics analysis statistical no significant differences were found for the variable hyperplasia, fibrosity and intensity of the inflammation when evaluated separately. When the interaction of the three variables was evaluated, also no statistical significant differences were found, having the two groups presented very close results. On the basis of the results obtained in this study, it was not possible to affirm that the present methodology allows to establish that an implantation system can provide better condition to the peri-implant soft tissue surroundings when compared with the other system.

Comparou-se pacientes diabéticos tipo 1 com pacientes controles saudáveis, para avaliar as condições periodontais e da mucosa, identificar, qualificar e inter-relacionar, com o nível glicêmico do diabético, a presença de leveduras na gengiva e na saliva, através de: teste de hemoglobina glicosilada, índice de placa, índice gengival, índice de sangramento gengival, o nível de inserção, a profundidade de sondagem, exame radiográfico, inspeção da mucosa, teste de fluxo salivar e exame microbiológico. As diferenças não foram significantes quanto às condições periodontais e de mucosa, entre os pacientes, nem quanto à prevalência de leveduras entre os locais amostrados, exceto que os pacientes diabéticos mais velhos apresentaram nível de inserção clínica 77% maior que os mais jovens e o dobro de leveduras que os demais grupos. A C. albicans foi a levedura mais freqüente. Concluiu-se que houve uma leve tendência dos pacientes diabéticos apresentarem uma susceptibilidade aumentada à doença periodontal e maior frequência de leveduras, não podendo generalizar e estender os resultados de uma população tão pequena, sugerindo que se avalie uma população maior. / This work assessed (a) the differences of periodontal and soft tissue conditions, between diabetics type 1 patients, (b) the prevalence and comparison of yeast in gingival and saliva, (c) possible association between yeast with glycaemic conditions of the diabetic patients. Twenty-four patients were subdivided in 3 groups: diabetic subjects aging from 13 to 19 years (A) and aging from 20 or more years (B) and healthy controls (C) with periodontal diseases, aging from 20 or more years. There were performed the hemoglobin glycated test, radiological examination, anamnestic information, periodontal and soft tissues condition, salivary flow and microbiological analysis of the gingival and saliva; the plaque index, gingival index, bleeding sulcular index, clinical attachment level and probing depth were recorded. There were no significant differences in relation to the periodontal and mucosa conditions between diabetic patients, exception was to group B that showed 77% more attachment loss than group A. The results showed no significant differences in the prevalence of yeast, however there were twice more numbers of yeast in group B. C. albicans was the most frequent detected yeast. Although data from this study were not significant, a slightly tendency to a high prevalence of yeast and an increased susceptibility to periodontal diseases in diabetic population were shown. So, it would be prudent to elucidate in a greater population.

The role of the immune system in periodontal disease has been well established. Individuals who smoke are more prone to developing periodontitis because of the excess plaque buildup and the immune system's attack of the bacteria on the gingiva. This study aims to examine the role of immunotherapy in the reversal of periodontal disease in individuals who smoke. Further research will not only assist with the reversal of periodontitis, but may also improve other debilitating co-morbid diseases including autoimmune diseases such as human immunodeficiency virus. To examine this question, a variety of research studies from various sources were examined. There are numerous factors, which contribute to the initiation and progression of periodontal disease. Use of nicotine products enhances the accumulation of plaque formation. Accumulation of large amounts of plaque and calculus assist in the progression of periodontal disease. Disease of the gingiva may lead numerous other debilitating diseases such as respiratory infections, Alzheimer's disease and unfavorable pregnancy outcomes. Two components of the immune system play a major role in gingival inflammation observed in smokers; these include cytokine production and inflammation. The concentration of pro-inflammatory cytokines released from the macrophages of smokers is significantly higher than that observed in non-smokers. Pro-inflammatory cytokines, such as TNF-alpha, are responsible for inflammation of the gingiva. The use of pre-existing immunotherapy treatments may be beneficial and assist in the reversal of periodontal disease. Further researcher on immune therapy, which has been shown to be successful in other disease treatments will not only be beneficial for the oral cavity, but for overall systemic health. Both immune and bacterial components should be taken into consideration when developing therapies for periodontal disease. Pro-inflammatory cytokines such as TNF-alpha are dramatically increased in smokers. Researchers should model therapies after existing therapies that have been successful for other diseases such as immunotherapy studies with lamvidine (Hepatitis B), lambrolixumab (melanoma) and infliximad (oral plaque). The mTOR signaling pathway controls the release of pro-inflammatory and anti-inflammatory cytokines. Deletion of the raptor protein causes more inflammation in the colon due to an increased release of pro-inflammatory cytokines. Therapies which directly act upon this signaling pathway should be further researched upon to reverse the effects of periodontal disease. Chromogranin A release showed a significant increase in smokers because of the body's ability to want to automatically attach the harsh environment created by tobacco. Modulating the immune response induced by Chromagranin A or possibly through the use of anti-TNF-alpha therapies which have shown success in patients with rheumatoid arthritis also is open to future research. The shift from gram-negative to gram-positive bacteria was noted in periodontal disease patients. The less diverse bacteria lead to the loss of the ability of ligaments to attach to one another in the oral cavity. The development and testing of bacteria specific antibiotics such as Fusobacterium, Prevotella, and Selenomonas may prove to be very beneficial. There is much optimism among the dental professionals that immunotherapy may lead to the development of future therapies for periodontitis in both smokers and non-smokers. However we must also encourage patients to stop smoking through awareness and education.

Enxertos gengivais livres são importantes para garantir condições necessárias para o estabelecimento da homeostasia do periodonto de proteção. O processo de inflamação não ocorre por igual em todos os tecidos conjuntivos do organismo e os fibroblastos têm a capacidade de reagir a estímulos agressivos por meio de liberação de diversas citocinas, que desempenham importante função na formação do infiltrado inflamatório. Até o presente trabalho, não há relatos na literatura acerca da comparação do comportamento dos fibroblastos que compõem a mucosa palatina não marginal e dos fibroblastos provenientes de enxerto gengival livre (EGL) marginal em resistir aos estímulos agressores que ocorrem na doença periodontal. Dessa forma, a proposta do presente trabalho foi investigar se os fibroblastos da mucosa palatina não marginal mudariam seu perfil de secreção de citocinas quando enxertados na margem gengival. Foram coletadas biópsias da mucosa palatina no momento da cirurgia de EGL (período inicial) e após 4 meses (período final) no momento da cirurgia para recobrimento radicular. Os fibroblastos foram cultivados e estimulados com LPS de Porphyromonas gingivalis (Pg) e de Escherichia coli (Ec) por 24h e 48h para avaliação comparativa da expressão de citocinas e mediadores do reparo tecidual, como: IL-6, IL-8/CXCL8, MIP-1α/CCL3, TGF-β, VEGF e CXCL16. As citocinas foram quantificadas no sobrenadante das células por meio de ensaio imunoenzimático (ELISA). Para a citocina IL-6, os fibroblastos da mucosa palatina não marginal mantiveram o mesmo perfil de secreção quando enxertados na área gengival marginal; para MIP-1α a secreção se mostrou aumentada de forma estatisticamente significativa pelos fibroblastos obtidos do enxerto gengival marginal após 48h de estímulo por Pg em comparação com os fibroblastos da área palatina não marginal; a secreção de IL-8 pelos fibroblastos da mucosa palatina não marginal foi maior em resposta ao desafio por LPS de Pg e os fibroblastos obtidos do enxerto gengival marginal exibiram secreção até mesmo sem o estímulo de LPS; apenas os fibroblastos do enxerto gengival marginal apresentaram secreção de TGF-β, mesmo na ausência de estímulo por LPS; a secreção de VEGF e CXCL16 não foi detectada pelos fibroblastos analisados. Conclui-se que os fibroblastos provenientes de uma mucosa palatina não marginal parecem se adaptar às condições locais quando enxertados na área gengival marginal, oferecendo evidência de sua participação efetiva na produção de mediadores inflamatórios importantes para o processo de homeostasia do periodonto marginal. / Free gingival grafts are important to ensure conditions for the establishment of homeostasis of the periodontal soft tissues. The process of inflammation does not occur the same way in all connective tissues and fibroblasts have the ability to respond to aggressive stimuli through the release of various cytokines, which play an important role in the inflammatory infiltrate formation. In literature, there are no studies comparing the behavior of fibroblasts from palatal mucosa (not marginal) and fibroblasts from marginal free gingival graft (FGG) regarding their resistance towards periodontal disease aggressive stimuli. Thus, the purpose of this study was to investigate whether fibroblasts from the palatal mucosa behave differently when grafted to the gingival margin considering their mechanism of cytokine secretion. Biopsies from the palatal mucosa were collected at the time of FGG surgery (initial period) and after 4 months (final period) when surgery for root coverage was performed. The fibroblasts were cultured and stimulated with LPS of Porphyromonas gingivalis (Pg) and Escherichia coli (Ec) for 24 and 48 hours in order to make a comparative evaluation of cytokines and mediators of tissue repair expression, such as IL-6, IL-8/CXCL8, MIP-1α/CCL3, TGF-β, VEGF and CXCL16. Cytokines were measured in the cell supernatant by enzyme immunoassay (ELISA). For cytokine IL- 6, fibroblasts from palatal mucosa maintained the same secretion pattern when grafted to the gingival margin; for MIP-1α the secretion was significantly increased by fibroblasts from the marginal gingival graft after 48 hours of stimulation with Pg when compared to palatal mucosa fibroblasts; IL-8 secretion by palatal mucosa fibroblasts did not increase in response to Pg LPS challenge and fibroblasts from marginal gingival graft showed secretion even without the stimulus of LPS; only fibroblasts from marginal gingival graft showed secretion of TGF-β, even in the absence of LPS stimulation; VEGF and CXCL16 secretion by fibroblasts was not detected. It was concluded that fibroblasts from palatal mucosa seem to adapt to local conditions when grafted to the gingival margin area, providing evidence of its effective participation in the homeostasis of marginal periodontium through the production of important inflammatory mediators.

Comparou-se pacientes diabéticos tipo 1 com pacientes controles saudáveis, para avaliar as condições periodontais e da mucosa, identificar, qualificar e inter-relacionar, com o nível glicêmico do diabético, a presença de leveduras na gengiva e na saliva, através de: teste de hemoglobina glicosilada, índice de placa, índice gengival, índice de sangramento gengival, o nível de inserção, a profundidade de sondagem, exame radiográfico, inspeção da mucosa, teste de fluxo salivar e exame microbiológico. As diferenças não foram significantes quanto às condições periodontais e de mucosa, entre os pacientes, nem quanto à prevalência de leveduras entre os locais amostrados, exceto que os pacientes diabéticos mais velhos apresentaram nível de inserção clínica 77% maior que os mais jovens e o dobro de leveduras que os demais grupos. A C. albicans foi a levedura mais freqüente. Concluiu-se que houve uma leve tendência dos pacientes diabéticos apresentarem uma susceptibilidade aumentada à doença periodontal e maior frequência de leveduras, não podendo generalizar e estender os resultados de uma população tão pequena, sugerindo que se avalie uma população maior. / This work assessed (a) the differences of periodontal and soft tissue conditions, between diabetics type 1 patients, (b) the prevalence and comparison of yeast in gingival and saliva, (c) possible association between yeast with glycaemic conditions of the diabetic patients. Twenty-four patients were subdivided in 3 groups: diabetic subjects aging from 13 to 19 years (A) and aging from 20 or more years (B) and healthy controls (C) with periodontal diseases, aging from 20 or more years. There were performed the hemoglobin glycated test, radiological examination, anamnestic information, periodontal and soft tissues condition, salivary flow and microbiological analysis of the gingival and saliva; the plaque index, gingival index, bleeding sulcular index, clinical attachment level and probing depth were recorded. There were no significant differences in relation to the periodontal and mucosa conditions between diabetic patients, exception was to group B that showed 77% more attachment loss than group A. The results showed no significant differences in the prevalence of yeast, however there were twice more numbers of yeast in group B. C. albicans was the most frequent detected yeast. Although data from this study were not significant, a slightly tendency to a high prevalence of yeast and an increased susceptibility to periodontal diseases in diabetic population were shown. So, it would be prudent to elucidate in a greater population.

Thesis--University of Oklahoma. / Bibliography: leaves 101-104.

Thesis (M.S.)--University of Michigan, 1984.