Balance between matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) is required for normal wound healing. Chronic inflammation, such as that seen in cardiovascular and periodontal diseases, may upset this balance. The aim of this study was to determine whether initial periodontal therapy would have an effect systemically on the levels of MMP-9 and TIMP-1. Twenty-one patients with generalized chronic periodontitis were enrolled in the study. Clinical examinations were conducted and parameters measured. Scaling and root planing was performed and blood analysis done to determine the plasma concentrations of MMP-9 and serum concentrations of TIMP-1. Initial periodontal therapy resulted in improvements in gingival inflammation and plaque levels. No effect on the plasma concentrations of MMP-9 and serum concentrations of TIMP-1 could be found following therapy.

A raspagem subgengival e o alisamento radicular constituem o "padrão ouro" e o tratamento de eleição para a periodontite; porém, é um procedimento difícil de ser executado, que requer um intenso treinamento e que pode expor a dentina, causando hipersensibilidade dentinária pela remoção excessiva de cemento, ou produzir defeitos, como sulcos e ranhuras, além de deixar cálculo residual e não conseguir atingir toda as superfície radicular. Recentemente, um gel a base de papaína e cloramina foi introduzido no mercado (Papacárie), utilizado no tratamento da remoção de dentina cariada. Este gel poderia auxiliar na remoção do cálculo subgengival com menor desgaste do cemento. O objetivo deste trabalho foi comparar a eficácia e analisar a superfície radicular na utilização de um gel à base de papaína e cloramina, associado ao alisamento radicular, na região subgengival. Após receberem instruções de higiene oral, raspagem supragengival e polimento coronário, 18 pacientes com periodontite crônica, 6 mulheres e 12 homens, com idade média de 51 anos (8) foram tratados num modelo de boca dividida. O tratamento-teste foi constituído pela aplicação do gel na área subgengival por 1 min., seguida pelo alisamento radicular; o tratamento-controle foi constituído pela raspagem subgengival e alisamento radiculares. A terapia foi executada por 3 operadoras e os exames inicial, de 28 dias e 3 meses, foram realizados por um único examinador. Quatro dentes nunca tratados de dois outros pacientes (2 incisivos centrais inferiores e 2 premolares), com indicação para extração, foram submetidos ao tratamento teste e controle e, após a exodontia, analisados em microscopia eletrônica de varredura (MEV). Ao longo dos 3 meses, os resultados demonstraram significativa melhora nos parâmetros clínicos: sangramento à sondagem, profundidade de bolsa e ganho de inserção, tanto no lado-teste, como no lado-controle, principalmente aos 28 dias; mas não foi observada significância estatística quando ambas as formas de terapia foram comparadas. O índice de placa médio permaneceu alto ao longo do estudo. A análise do MEV demonstrou que o tratamento-teste deixou uma maior quantidade de cálculo residual sobre a superfície radicular; porém, áreas livres de cálculo também foram observadas. No tratamento-controle, verificaram-se regiões mais profundas não atingidas pelas curetas, áreas livres de cálculo e um sulco produzido pela cureta. Concluiu-se que tanto o tratamento-teste, como o controle, foram eficazes no tratamento da periodontite crônica nos 3 meses observados. / Although subgingival scaling and root planing are the gold standard for elective treatment of periodontitis, they are difficult procedures to perform. As well as requiring intensive training, they can expose the dentin, causing dentin hypersensitivity by excessive removal of cement, or produce defects such as ridges and grooves, leaving residual calculus, whilst the whole root surface cannot be reached. A papain- and chloramine-based gel (Papacárie) has recently been introduced to remove carious dentin. This gel may help in the removal of subgingival calculus with reduced consumption of cement. The objective of this study was to compare the effectiveness of a papain- and chloramine-based gel and analyze the root surface in the region associated with subgingival root planing. After receiving oral hygiene instructions, supragingival scaling and coronary polishing, 18 chronic periodontitis patients (6 women and 12 men with a mean age of 51 years 8) were treated using a split-mouth model. The test treatment was established by applying the gel to the subgingival area for 1 minute, followed by root planing; whilst the control treatment was established by subgingival scaling and root planing. The therapy was performed by 3 operators, examinations initially and after 28 days and 3 months being performed by a single examiner. Four previously untreated teeth (2 lower central incisors and 2 premolars) with indication for extraction in two other patients were treated as test and control and analyzed by scanning electron microscopy (SEM) following extraction. Although over the 3 months the results showed marked improvement in clinical parameters: bleeding on probing, pocket depth and attachment gain on both test and control sides, especially after 28 days; the difference between the two forms of therapy was not found to be statistically significant. The mean plaque index remained high throughout the study. The SEM analysis showed that the test treatment left a larger amount of residual calculus on the root surface, but areas free of calculus were also observed. In the control treatment, deeper areas unaffected by the scaling and root planing, areas free of calculus and a groove produced by the curette were found. It was concluded that both test and control treatments were effective in the treatment of chronic periodontitis observed over 3 months.

Made available in DSpace on 2014-06-11T19:33:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2003-06-18Bitstream added on 2014-06-13T19:04:26Z : No. of bitstreams: 1 theodoro_lh_dr_arafo.pdf: 4192650 bytes, checksum: 68b3ce4f45242d419b74abad0df09354 (MD5) / O objetivo deste estudo foi avaliar in vitro, a adesão de elementos sanguíneos sobre superfícies radiculares irradiadas com laser de Er:YAG e de Diodo, e a ação destes sobre as superfícies radiculares. Foram obtidas 120 amostras de dentes humanos extraídos por doença periodontal, que foram previamente raspados e aplainados com instrumentos manuais, sendo a seguir divididas aleatoriamente em 6 grupos com 20 amostras cada. O G1 (controle)- não recebeu nenhum tratamento; o G2- recebeu aplicação tópica de EDTA 24%; G3- foi irradiado com laser de Er:YAG com 7,6 J/cm2; o G4- irradiado com laser de Er:YAG com 12,9 J/cm 2; o G5 -irradiado com laser de Diodo com 90 J/cm2 e o G6 - foi irradiado com laser de Diodo com 108 J/cm2. Após a realização dos tratamentos, em 10 amostras de cada grupo foi depositado imediatamente a sua punção, tecido sanguíneo originado da vascularização periférica de humano, sendo que 10 amostras não receberam tal tratamento. Após processamento laboratorial as amostras foram analisadas através de microscopia eletrônica de varredura. As fotomicrografias obtidas foram avaliadas através de dois índices: adesão de elementos sanguineos e de morfologia da superfície radicular e estatisticamente analisadas (Kruskall Wallis e Mann-Whitney). Os resultados demonstraram que em relação a adesão de elementos sanguíneos não houve diferenças estatisticamente significante entre o grupo controle e os tratados com o laser de Er:YAG (p=0,7733 e 0,7831) ; O G5 mostrou-se menos efetivo que o controle na adesão de elementos sanguíneos ( p=0,0305 ) e o G2 foi o menos efetivo de todos na adesão. Com relação a morfologia da superfície radicular houve diferenças significantes entre o controle e os grupos do laser de Er:YAG (p= 0,0001) e entre o G5 do Diodo (0,0259); entre o EDTA e os grupos do laser de Er:YAG (p=0,0150 ) e entre o... . / The aim of this study was to evaluate in vitro the adhesion of blood components on root surfaces irradiated with Er:YAG and Diode lasers and these lasers effects on root surfaces. It was obtained 120 samples of human teeth extracted by periodontal disease. They were planed and scaled previously with manual instruments and randomly divided into 06 groups of 20 samples each. The groups were treated according to the following procedures: G1 (Control Group) -received no treatment; G2- had a topical application of EDTA 24%; G3- was irradiated with Er:YAG laser (7,6 J/cmø); G4 - was irradiated with Er:YAG laser (12,9 J/cmø); G5 - was irradiated with Diode laser (90 J/cmø) and G6 was irradiated with Diode laser (108 J/cmø). After these treatments were conducted, 10 samples of each group received a stippler, a blood tissue originated from peripheral vascularization, and the reminiscent samples did not receive such treatment. After laboratorial analysis the samples were analyzed through a scanning electronic microscopy. The photomicrographs obtained were evaluated according to adhesion of blood components and morphology of root surface; and statistically analyzed (Kruskall Wallis and Mann-Whitney). With relation to the adhesion of blood components, the results have shown that there were no significant differences between the Control Group and the groups treated with Er:YAG laser (p=0,7733 and 0,7831); G5 was less effective than the Control Group in adhesion of blood components (p=0,0305) and G2 was the least effective of all groups in this case. With relation to the morphology of root surface there were significant differences among the Control Group, the Er:YAG laser groups (p=0,0001) and the Diode laser G5 (p=0,0259); between the EDTA and the Er:YAG laser groups (p=0,0150) and also between the Diode laser G6 and the Er:YAG laser groups (p=0,0032)... (Complete abstract, click electronic address below).

A raspagem subgengival e o alisamento radicular constituem o "padrão ouro" e o tratamento de eleição para a periodontite; porém, é um procedimento difícil de ser executado, que requer um intenso treinamento e que pode expor a dentina, causando hipersensibilidade dentinária pela remoção excessiva de cemento, ou produzir defeitos, como sulcos e ranhuras, além de deixar cálculo residual e não conseguir atingir toda as superfície radicular. Recentemente, um gel a base de papaína e cloramina foi introduzido no mercado (Papacárie), utilizado no tratamento da remoção de dentina cariada. Este gel poderia auxiliar na remoção do cálculo subgengival com menor desgaste do cemento. O objetivo deste trabalho foi comparar a eficácia e analisar a superfície radicular na utilização de um gel à base de papaína e cloramina, associado ao alisamento radicular, na região subgengival. Após receberem instruções de higiene oral, raspagem supragengival e polimento coronário, 18 pacientes com periodontite crônica, 6 mulheres e 12 homens, com idade média de 51 anos (8) foram tratados num modelo de boca dividida. O tratamento-teste foi constituído pela aplicação do gel na área subgengival por 1 min., seguida pelo alisamento radicular; o tratamento-controle foi constituído pela raspagem subgengival e alisamento radiculares. A terapia foi executada por 3 operadoras e os exames inicial, de 28 dias e 3 meses, foram realizados por um único examinador. Quatro dentes nunca tratados de dois outros pacientes (2 incisivos centrais inferiores e 2 premolares), com indicação para extração, foram submetidos ao tratamento teste e controle e, após a exodontia, analisados em microscopia eletrônica de varredura (MEV). Ao longo dos 3 meses, os resultados demonstraram significativa melhora nos parâmetros clínicos: sangramento à sondagem, profundidade de bolsa e ganho de inserção, tanto no lado-teste, como no lado-controle, principalmente aos 28 dias; mas não foi observada significância estatística quando ambas as formas de terapia foram comparadas. O índice de placa médio permaneceu alto ao longo do estudo. A análise do MEV demonstrou que o tratamento-teste deixou uma maior quantidade de cálculo residual sobre a superfície radicular; porém, áreas livres de cálculo também foram observadas. No tratamento-controle, verificaram-se regiões mais profundas não atingidas pelas curetas, áreas livres de cálculo e um sulco produzido pela cureta. Concluiu-se que tanto o tratamento-teste, como o controle, foram eficazes no tratamento da periodontite crônica nos 3 meses observados. / Although subgingival scaling and root planing are the gold standard for elective treatment of periodontitis, they are difficult procedures to perform. As well as requiring intensive training, they can expose the dentin, causing dentin hypersensitivity by excessive removal of cement, or produce defects such as ridges and grooves, leaving residual calculus, whilst the whole root surface cannot be reached. A papain- and chloramine-based gel (Papacárie) has recently been introduced to remove carious dentin. This gel may help in the removal of subgingival calculus with reduced consumption of cement. The objective of this study was to compare the effectiveness of a papain- and chloramine-based gel and analyze the root surface in the region associated with subgingival root planing. After receiving oral hygiene instructions, supragingival scaling and coronary polishing, 18 chronic periodontitis patients (6 women and 12 men with a mean age of 51 years 8) were treated using a split-mouth model. The test treatment was established by applying the gel to the subgingival area for 1 minute, followed by root planing; whilst the control treatment was established by subgingival scaling and root planing. The therapy was performed by 3 operators, examinations initially and after 28 days and 3 months being performed by a single examiner. Four previously untreated teeth (2 lower central incisors and 2 premolars) with indication for extraction in two other patients were treated as test and control and analyzed by scanning electron microscopy (SEM) following extraction. Although over the 3 months the results showed marked improvement in clinical parameters: bleeding on probing, pocket depth and attachment gain on both test and control sides, especially after 28 days; the difference between the two forms of therapy was not found to be statistically significant. The mean plaque index remained high throughout the study. The SEM analysis showed that the test treatment left a larger amount of residual calculus on the root surface, but areas free of calculus were also observed. In the control treatment, deeper areas unaffected by the scaling and root planing, areas free of calculus and a groove produced by the curette were found. It was concluded that both test and control treatments were effective in the treatment of chronic periodontitis observed over 3 months.

Orientador: José Eduardo Cezar Sampaio / Banca: Rosemary Adriana Chiérici Marcantonio / Banca: Álvaro Francisco Bosco / Banca: Denise Maria Zezel / Banca: Antônio Wilson Sallum / Resumo: O objetivo deste estudo foi avaliar in vitro, a adesão de elementos sanguíneos sobre superfícies radiculares irradiadas com laser de Er:YAG e de Diodo, e a ação destes sobre as superfícies radiculares. Foram obtidas 120 amostras de dentes humanos extraídos por doença periodontal, que foram previamente raspados e aplainados com instrumentos manuais, sendo a seguir divididas aleatoriamente em 6 grupos com 20 amostras cada. O G1 (controle)- não recebeu nenhum tratamento; o G2- recebeu aplicação tópica de EDTA 24%; G3- foi irradiado com laser de Er:YAG com 7,6 J/cm2; o G4- irradiado com laser de Er:YAG com 12,9 J/cm 2; o G5 -irradiado com laser de Diodo com 90 J/cm2 e o G6 - foi irradiado com laser de Diodo com 108 J/cm2. Após a realização dos tratamentos, em 10 amostras de cada grupo foi depositado imediatamente a sua punção, tecido sanguíneo originado da vascularização periférica de humano, sendo que 10 amostras não receberam tal tratamento. Após processamento laboratorial as amostras foram analisadas através de microscopia eletrônica de varredura. As fotomicrografias obtidas foram avaliadas através de dois índices: adesão de elementos sanguineos e de morfologia da superfície radicular e estatisticamente analisadas (Kruskall Wallis e Mann-Whitney). Os resultados demonstraram que em relação a adesão de elementos sanguíneos não houve diferenças estatisticamente significante entre o grupo controle e os tratados com o laser de Er:YAG (p=0,7733 e 0,7831) ; O G5 mostrou-se menos efetivo que o controle na adesão de elementos sanguíneos ( p=0,0305 ) e o G2 foi o menos efetivo de todos na adesão. Com relação a morfologia da superfície radicular houve diferenças significantes entre o controle e os grupos do laser de Er:YAG (p= 0,0001) e entre o G5 do Diodo (0,0259); entre o EDTA e os grupos do laser de Er:YAG (p=0,0150 ) e entre o... (Resumo completo, clicar acesso eletrônico abaixo). / Abstract: The aim of this study was to evaluate in vitro the adhesion of blood components on root surfaces irradiated with Er:YAG and Diode lasers and these lasers effects on root surfaces. It was obtained 120 samples of human teeth extracted by periodontal disease. They were planed and scaled previously with manual instruments and randomly divided into 06 groups of 20 samples each. The groups were treated according to the following procedures: G1 (Control Group) -received no treatment; G2- had a topical application of EDTA 24%; G3- was irradiated with Er:YAG laser (7,6 J/cmø); G4 - was irradiated with Er:YAG laser (12,9 J/cmø); G5 - was irradiated with Diode laser (90 J/cmø) and G6 was irradiated with Diode laser (108 J/cmø). After these treatments were conducted, 10 samples of each group received a stippler, a blood tissue originated from peripheral vascularization, and the reminiscent samples did not receive such treatment. After laboratorial analysis the samples were analyzed through a scanning electronic microscopy. The photomicrographs obtained were evaluated according to adhesion of blood components and morphology of root surface; and statistically analyzed (Kruskall Wallis and Mann-Whitney). With relation to the adhesion of blood components, the results have shown that there were no significant differences between the Control Group and the groups treated with Er:YAG laser (p=0,7733 and 0,7831); G5 was less effective than the Control Group in adhesion of blood components (p=0,0305) and G2 was the least effective of all groups in this case. With relation to the morphology of root surface there were significant differences among the Control Group, the Er:YAG laser groups (p=0,0001) and the Diode laser G5 (p=0,0259); between the EDTA and the Er:YAG laser groups (p=0,0150) and also between the Diode laser G6 and the Er:YAG laser groups (p=0,0032)... (Complete abstract, click electronic address below). / Doutor

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