Objetivo: Avaliar o comprometimento orofacial em dermatomiosite juvenil (DMJ). Métodos: Vinte e seis pacientes com DMJ foram estudados e comparados a 22 controles saudáveis. A avaliação orofacial incluiu: características clínicas, avaliação dentária e periodontal, função mandibular e fluxo salivar. Também foram avaliadas as características clínicas e scores da DMJ, enzimas musculares e tratamento. Resultados: A média da idade atual foi similar em pacientes e controles (p>0.05). Uma alteração gengival específica, caracterizada por eritema, dilatação de capilares e formação em arbustos foi observado somente em pacientes com DMJ (61% vs.0%, p=0,0001). As freqüências de mobilidade mandibular alterada e abertura de boca diminuída foram significativamente maiores em DMJ versus controles (50% vs. 14%, p=0,013; 31% vs. 0, p=0,005). Comparando pacientes com DMJ com e sem alteração gengival específica, observamos que os pacientes sem alteração gengival apresentaram menores valores de limite esmalte-cemento (- 0.26 vs.-0.006mm, p=0,013) e maior índice de sangramento gengival (27.7% vs.14%, p=0,046). Este padrão de alteração gengival não foi associado à doença periodontal [índice de placa (p=0,332) e perda de inserção dentária (p=0,482)]. A mediana do índice disease activity score(DAS) cutâneo e a dose atual de metotrexate foi maior nos pacientes com alteração gengival (2,5 vs.0,5, p=0,029; 28.7 vs.15, p=0.012). Pacientes com DMJ e limitaçao de abertura de boca apresentaram mediana significativamente menor do manual muscle testing(MMT) quando comparados a pacientes com DMJ sem limitação de abertura de boca (79 vs.80, p=0.002). Conclusão: O padrão gengival característico, associado à atividade cutânea da doença, e diferente de doença periodontal, sugere que a gengiva seja um possível tecido alvo para DMJ. Além disto, fraqueza muscular pode ser um fator relevante para a mobilidade mandibular. / Objective: To assess orofacial involvement in juvenile dermatomyositis (JDM). Methods: Twenty-six JDM patients were studied and compared to 22 healthy controls. Orofacial evaluation included clinical features, dental and periodontal assessment, mandibular function and salivary flow. JDM clinical features, scores, muscle enzymes and treatment were also assessed. Results: The media of current age was similar in JDM patients and controls (p>0.05). A peculiar gingival alteration characterized by erithema, capillary dilation and bush loop formation was only observed in JDM patients (61% vs.0%, p=0.0001). The frequencies of altered mandibular mobility and reduced mouth opening were significantly higher in JDM versus controls (50% vs. 14%, p=0.013; 31% vs. 0, p=0.005). The comparison of JDM patients with and without gingival alteration showed that the former had lower values of median of cementoenamel junction (-0.26 vs.-0.06mm, p=0.013) and higher gingival bleeding index (27.7% vs.14%, p=0.046). Of note, this pattern of gingival alteration was not associated with periodontal disease [plaque index (p=0.332 and dental attachment loss (p=0.482)]. The median of skin disease activity score(DAS) and current dose of methotrexate were higher in JDM with gingival alteration (2.5 vs.0.5, p=0.02; 28.7 vs.15, p=0.001). A significant association of lower median manual muscle testing(MMT) with reduced mouth opening was observed in JDM compared to patients without this alteration (79 vs.80, p=0.002). Conclusions: The peculiar gingival pattern associated with cutaneous disease activity, distinct from periodontal disease, suggest that gingiva is a possible target tissue for JDM. In addition, muscle weakness may be a relevant factor for mandibular mobility.

Orientador: Enilson Antonio Sallum / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-22T18:53:40Z (GMT). No. of bitstreams: 1 Moreira_AnaReginaOliveira_M.pdf: 1385721 bytes, checksum: d11464d4ccf02ff2d2d33193a7be737f (MD5) Previous issue date: 2013 / Resumo: O objetivo do presente estudo foi comparar o resultado clínico do retalho posicionado coronariamente associado (RPC) ou não a enxerto de matriz de colágeno de origem suína (MG) no tratamento de retrações gengivais localizadas. Para este estudo clínico controlado, randomizado, cego, foram selecionados 30 pacientes com retrações gengivais Classe I ou II de Miller ? 2 mm, em dentes caninos ou pré-molares superiores. Os 30 defeitos foram aleatoriamente designados para o grupo RPC ou para o grupo RPC+MG. Os parâmetros clínicos avaliados foram: profundidade de sondagem, nível de inserção clínico, altura e largura da retração gengival, altura e espessura de tecido queratinizado, altura e largura da papila interdental, hipersensibilidade dentinária e satisfação estética. As medidas clínicas foram tomadas imediatamente antes da cirurgia e 45 dias, 2, 3 e 6 meses após as cirurgias. Nenhuma diferença estatisticamente significante foi observada entre os grupos em relação à redução da retração gengival, embora tenha sido encontrada maior porcentagem de cobertura radicular no grupo RPC+MG (77,8%), quando comparado ao RPC (72,5%) (p<0,05). Cobertura radicular completa foi obtida em 40% dos sítios tanto no RPC quanto no grupo RPC+MG. Ao final do estudo, o ganho na espessura de tecido queratinizado foi 0,21 mm maior para o grupo RPC+MG (p<0,05). Nenhum dos tratamentos reduziu hipersensibilidade dentinária de forma significativa (p>0,05), mas resultaram em aumento estatisticamente significante na satisfação estética dos pacientes (p<0,05), sendo esta maior quando o MG não foi utilizado (p<0,05). Dentro dos limites do presente estudo pôde-se concluir que o RPC, associado ou não a MG, levou a redução significativa da retração gengival, sem diferença estatística entre os grupos. Entretanto, quando MG foi utilizado, houve ganhado adicional na espessura de tecido queratinizado / Abstract: The aim of this study was to compare the clinical outcome of the coronally advanced flap technique (CAF) associated or not to a porcine collagen matrix graft (MG) in the treatment of localized gingival recessions. For this blinded randomized controlled clinical trial, 30 patients with Miller Class I or II gingival recession ? 2 mm in canines or premolars were selected. The 30 defects were randomly assigned to the CAF group or to the CAF+MG group. The clinical parameters evaluated were probing depth, clinical attachment level, gingival recession height, gingival recession width, height and thickness of keratinized tissue, height and width of interdental papilla, dentin hypersensitivity and aesthetic satisfaction. Clinical measurements were taken at baseline and 45 days, 2, 3 and 6 months after surgery. No statistically significant difference was observed between the two groups regarding gingival recession reduction, although it was found the highest percentage of root coverage in CAF + MG group (77.8%) compared to the CAF alone (72.5%) (p<0.05). Complete root coverage was achieved in 40% of the sites in both CAF and CAF + MG group. At the end of the study, the gain in keratinized tissue thickness was 0.21 mm higher in CAF + MG group (p <0.05). None of the treatments significantly reduced dentin hypersensitivity (0>0.05), but resulted in increased patient-reported aesthetic satisfaction (p<0.05), which was higher when the MG was not used (p<0.05). Within the limits of this study, it can be concluded that CAF, with or without MG, resulted in significant gingival recession reduction, with no statistical difference between groups. However, when MG was used, there was additional gain in keratinized tissue thickness / Mestrado / Periodontia / Mestra em Clínica Odontológica

No description available.

A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Background: Therapeutic management of bone loss in the craniofacial region as a consequence of trauma, surgery or congenital malformations presents a clinical challenge. Mesenchymal stem cells (MSCs), due to their inherent plasticity, are potential candidates for cell based therapies for the repair and reconstruction of craniofacial bone tissue. Guided differentiation of stem cells to osteogenic precursors is marked by spatio-temporally regulation of gene expression profiles including that of transcription factors, cytokines, extracellular matrix proteins, enzymes and several signaling pathways. Cytokines, produced by both immune and non-immune cells can influence both immuno- modulatory responses in the host and also affect cell physiology. Understanding the cytokine expression profiles will be of great advantage in developing methods for effective bone regeneration with minimal immunological insults either on the graft or on the host. Objective: The objective of the present study is to investigate the gene expression profiles of the various cytokines of HGMSCs in normal and osteogenic conditions. Methodology: HGMSCs were isolated from gingival tissues by standard enzymatic methods. HGMSCs were guided to osteogenic precursor cells and the differentiation process was monitored by measuring stage specific expression of genes and proteins. Mineral nodule formation of osteogenic differentiation was analyzed by using Alizarin red and Von Kossa Staining methods. Gene expression profiles of various pro- and anti-inflammatory cytokine profiles of HGMSCs were investigated using quantitative real time PCR at 1, 2 and 3 weeks post-induction with osteogenic medium. Results: The osteogenic differentiation of HGMSCs was confirmed by alkaline phosphate enzyme activity assay, gene and protein expression studies of osteogenic markers. Mineral nodule formation was observed after 4 weeks ofosteogenic induction. The results of cytokine profile expressions revealed that there was a significant upregulation in the expression of TGF-β at all-time points. The gene expression of IL-10 was more or less consistent with an overall increase of 40% over that of controls at all time points studied. We observed a significant decrease in the mRNA expression of IL-6 and IL-1? with respect to their control group (P<0.05) and the expression of IL-8 was upregulated significantly. Conclusion: There is an overall enhancement in the expression of anti-inflammatory cytokines IL-10 and TGF-β during the osteogenic differentiation of HGMSCs that indicates a potential shift of cytokines to dampen immune responses. The reduction of IL-6 and IL-1β expression is an added advantage to reduce the acute phase and inflammatory responses, favoring HGMSCs to be cells of choice for repair and regeneration of craniofacial bones. A beneficial combination of the cytokines expressed by HGMSCs during osteogenic differentiation to reduce acute phase and long term immune responses will facilitate the achievement of our long term goal.

Bei der Stippelung handelt es sich um eine Oberflächenstruktur des Gingivaepithels, die der Gingiva ein orangenschalenartiges Aussehen verleiht. Ziel dieser Studie war es, die Stippelung der Gingiva von Kindern zu untersuchen und deren Merkmale sowie Prävalenz zu charakterisieren. Material und Methode: Für diese Querschnittsuntersuchung wurden insgesamt 274 Kinder untersucht (148 Jungen, 126 Mädchen; Durchschnittsalter 4,98 Jahre) und dabei der Zahnbefund, der Mundhygienezustand (API), der Entzündungszustand (PBI) und die ethnische Herkunft aufgenommen. Die Stippelung wurde photographisch und mit Abformung aus niedrig viskösem additionsvernetzenden Silikon dokumentiert. Die davon hergestellten Modelle wurden unter einem Stereomikroskop mit einer Kamera digitalisiert. Das Programm analySIS 3.0 diente zur Bildanalyse. Ergebnisse: Insgesamt zeigten 187 Kinder (68,2%) Stippelung (Jungen 67,2%, Mädchen 69%). Sie trat ab einem Alter von einem Jahr auf. Geschlecht, ethnische Herkunft, Karieserfahrung, API und PBI hatten keinen Einfluss auf die Häufigkeit. Sie kam signifikant häufiger im Wechselgebiss vor, ebenso im Oberkiefer und im Frontzahnbereich. Im Seitenvergleich konnte keine symmetrische Verteilung festgestellt werden. Die Tüpfelung kam bis auf eine Ausnahme ausschließlich auf der befestigten Gingiva vor und war dabei bevorzugt interradikulär, danach radikulär und zuletzt im subpapillären Bereich zu finden. Die Auswertung der Photographien und Replikas ergab eine durchschnittliche Dichte von 2,54 Stippel/mm2 bei einer Höhe von 0,10 mm bzw. einer Breite von 0,09 mm je Vertiefung. Ältere Kinder wiesen eine höhere Dichte der Tüpfelung auf. Alter und Geschlecht keinen Einfluss auf die morphometrischen Daten. Anzahl, Höhe und Breite der Stippelung waren im Oberkiefer und im Frontzahnbereich größer als im Unterkiefer bzw. im Seitenzahnbereich. Schlussfolgerung: Als alleiniges Kriterium zur Beurteilung des klinischen Entzündungszustandes der Gingiva bei Kindern ist die Stippelung nicht geeignet, da das Fehlen von Stippelung nicht immer mit dem Vorhandensein von gingivaler Entzündung übereinstimmt. Für eine korrekte Diagnose müssen vielmehr weitere Kriterien wie Farbe, Dicke, Festigkeit, Kontur der Gingiva, die Sondierungstiefe und Sondierungsblutung einbezogen werden. / Background: The aim of this study was to examine the gingival stippling in children and to characterize it. The prevalence of stippling was a special interest. Stippling is a structure of the gingival epithelium, which causes an orange peel like appearance of the gingiva. Material and methods: In this cross-sectional study 274 children (148 boys and 126 girls; average age 4.98 years) were examined. Oral status, approximal plaque index (API), papillary bleeding index (PBI) and race were noted. Photographs or replicas with a silicone impression material of low viscosity were taken if stippling was found. The replicas were used to make stone casts, which were scanned by a video camera. The obtained pictures were analysed with the software analysis 3.0. Results: 68.2% of the children showed stippling, in 67.2% of the boys and 69.0% of the girls. It was evident from an age of one year. Sex and race did not show any influence on prevalence. There was also no relation between stippling and caries, oral hygiene or gingival inflammation. Stippling was more frequent in mixed dentition than in deciduous dentition. The children showed more stippling in the upper jaw and in the anterior region. It was not spread symmetrically. Usually, it was localized to the attached gingiva with the highest frequency in the interradicular area, followed by the radicular area, and subpapillar area. Only one child showed stippling in the free gingiva, too, but this seemed to be an exception from the rule. The data obtained from photographs and replicas showed a density of 2,54 stipples per mm2, a height of 0.10 mm and a width of 0.09 mm. Older children showed a higher density. Height and width were neither influenced by sex nor by age. But stippling in upper arch and anterior region had a higher density and a larger height and width than in lower arch or posterior region. Conclusion: Gingival Stippling is not a major criterion in clinical assessment of gingival or periodontal inflammation, because missing stippling does not always coincide with presence of gingival inflammation. For a correct diagnosis more criteria, e.g. colour, contour, thickness, consistency, pocket depth and bleeding on probing, have to be considered, too.

The Dissertation work presented herein monitors the significance of oral hygiene in adults, while aiming at preventive measures leading to lowering mouth cavity illness occurrences. Within the theoretical part, I focus on the delineation of important terms relating to preventive care for oral cavity, information concerning anatomy, physiology of oral cavity, influence of foods and other problems within the oral cavity, among which there are tooth cavities and diseases of gingiva. In the practical part of the work I aim on the assessment of the level of oral health, trough the help of applied clinical research methodologies and investigative tooth indices such as API, PBI, and CPITN. Furthermore, educational materials are passed on, for the purpose of dissemination of needed information in the area of dental hygiene, teaching correct teeth brushing techniques, and utilization of other between-the-tooth tools. The following graphic presentation reveals the level of dental health. As well, within my work, I have verified that, within a larger proportion of patients an improved oral hygiene ensued; thanks to educational program together with an improved home oral hygiene care. Familiarity, care of oral cavity and dental hygiene are the most important prerequisites for each individual, when attempting to improve dental health.

Foi desenvolvido projeto de pesquisa clínica e radiográfica para avaliar a influência do ângulo formado entre a superfície dental e a crista óssea na determinação da profundidade de sondagem do sulco gengival e complementarmente no comportamento da margem gengival por vestibular de dentes molares inferiores inclinados para mesial. Para tanto foram incluídos 30 sítios mesiais e 30 distais no grupo teste, com igual número de sítios controles de molares inferiores com inclinação normal. Nos dentes que forneceram esses sítios também foi feita a determinação da profundidade do sulco gengival na região vestibular central do dente, identificando-se a qualidade e quantidade de gengiva ceratinizada, respectivamente pela metodologia de Kan et al. (2010) e pela mensuração com sonda periodontal da distância da margem gengival à junção mucogengival. Foram incluídos pacientes periodontal e sistemicamente saudáveis, excluindo-se pacientes que tivessem sido submetidos a procedimentos ósseos regenerativos prévios nas áreas de interesse, diabéticos relutantes ao controle médico, usuários de drogas e/ou álcool, portadores de alterações sistêmicas que interfiram no metabolismo ósseo (como por exemplo, osteoporose e hiperparatireoidismo). Os exames foram realizados por examinador competente, devidamente calibrado. Para análise radiográfica as imagens foram transferidas para o computador, realizando-se as mensurações dos ângulos interessados com o programa de computador MB-Ruler Pro (MB-Software solutions). A análise estatística foi realizada no programa GraphPad Prism versão 5.03 para Windows (GraphPad, Usa). Os resultados obtidos em linhas gerais mostraram que houve influência significativa do ângulo entre a superfície dental e a crista óssea (p > 0,0001) na determinação do sulco gengival proximal em áreas de dentes inclinados, porém não há essa influência na profundidade de sondagem do sulco gengival por vestibular para áreas com qualidade e quantidade de gengiva comparáveis ao controle (p=0,08). A despeito desses resultados, não se encontrou correlação definida entre nenhum dos parâmetros de interesse analisados. Dentro dos limites do estudo os resultados também evidenciaram que, embora possam ocorrer variações desses parâmetros, a saúde periodontal pode ser mantida pelo indivíduo nas condições analisadas. / A clinical and radiographic research project was developed to assess the influence of the angle formed between the tooth surface and the alveolar bone crest in determining the probing depth of the gingival sulcus and complementary also to evaluate the behavior of the buccal gingival margin of mesially inclined molars. Therefore, 30 mesial and 30 distal sites of inclined lower molars were included in the test group, with an equal number of sites of lower molars with normal inclination in the control group. In addition in all the teeth of both test and control groups the depth of the clinical gingival sulcus at the central buccal region of the tooth was assessed by measuring with a periodontal probe, identifying the quality of the keratinized gingiva through the methodology of Kan et al. (2010) and determining the width of keratinized gingiva by measuring the distance from the free gingival margin to the mucogingival junction. The study was done in systemic and periodontally healthy individuals, excluding patients who had undergone bone-regenerative procedures in the areas of interest, diabetics reluctant to medical control, alcohol and / or drug users, and individuals suffering from systemic conditions that might interfere with bone metabolism (like osteoporosis and hyperparathyroidism). The examinations were performed by a competent and properly calibrated examiner. The radiographic images were then transferred to a computer in order to analyze the measurements of the involved angles with the computer program MB-Ruler Pro (MB-Software solutions). Statistical analysis was performed using GraphPad Prism version 5.03 for Windows (GraphPad, Usa). The results in general showed that there was significant influence of the angle between the tooth surface and the alveolar bone crest on the depth of the gingival sulcus in proximal areas of inclined teeth (p > 0,0001), but there was no such influence in the probing depth of the buccal gingival sulcus of these inclined molars provided that the quality and quantity of gingiva were similar to controls comprised by molars with normal inclination (p=0,08). Despite this significance, there was no definite correlation between any of the analyzed parameters of interest. The results also showed that, although there may be variations of these parameters, within the limits of this study the conditions of periodontal health can be maintained by the individual.

Objetivo: Na maxila anterior em indivíduos com fissuras labiopalatinas, estabelecer medidas quantitativas dos tecidos moles (qualidade e quantidade da mucosa ceratinizada e medida do vestíbulo bucal) antes e após o enxerto ósseo alveolar secundário tardio (EOAS) com e sem a realização de vestíbuloplastia associada ao enxerto gengival autógeno livre (EGL), prévio ao EOAS tardio. Material e Métodos: O grupo A compreendeu 24 indivíduos com fissuras transforame incisivo unilaterais e o grupo B, 14 indivíduos totalizando 20 fissuras (8 com fissuras transforame incisivo unilaterais e 6 bilaterais). Antes da vestibuloplastia e EGL (grupo B), e pré e 2 meses após o EOAS (grupos A e B), foram medidas a espessura e largura da mucosa ceratinizada e a profundidade do vestíbulo bucal. Resultados: Após a vestibuloplastia e EGL, foram obtidas medidas satisfatórias no grupo B para a realização do EOAS, e após o EOAS, ambos os grupos demonstraram redução dessas medidas. Conclusão: A vestibuloplastia e o EGL antes do EOAS tardio produziram melhora em todos os parâmetros clínicos avaliados, sugerindo benefícios de sua realização neste período; entretanto, a decisão clínica, considerando a particularidade anatômica de cada fissura labiopalatina, deve ser o critério primordial para estabelecer a realização ou não destes procedimentos periodontais. / Objective: To establish quantitative measurements of soft tissues (quality and quantity of keratinized mucosa and measurement of buccal vestibule) in the anterior maxilla in individuals with cleft lip and palate before and after late secondary alveolar bone graft (SABG) with or without accomplishment of vestibuloplasty associated with free autogenous gingival graft (FGG), before the late SABG. Material and Methods: Group A was composed of 24 individuals with complete unilateral cleft lip and palate and Group B included 14 individuals adding up to 20 cleft sites (8 with complete unilateral cleft lip and palate and 6 with complete bilateral cleft lip and palate). Before vestibuloplasty and FGG (group B) and before and 2 months after SABG (groups A and B), the thickness and width of keratinized mucosa and depth of buccal vestibule were measured. Results: After vestibuloplasty and FGG satisfactory measurements were obtained for group B, for accomplishment of SABG, and after SABG both groups presented reduction of these measurements. Conclusion: Vestibuloplasty and FGG before late SABG improved all clinical parameters analyzed, suggesting benefits of its accomplishment in this period. However, the clinical decision considering the anatomical particularity of each cleft lip and palate should be the main criterion for indication of these periodontal procedures.

Orientador: Éder Ricardo Biazolla / Banca: Marcos Martins Curi / Banca: Luiz Paulo Kowalski / Banca: Eurípedes de Oliveira Marinho / Banca: Lúcio Murilo dos Santos / Resumo: Neste estudo foram avaliados 264 casos de carcinoma espinocelular de gengiva inferior, tratados no Centro de Tratamento e Pesquisa-Hospital do Câncer- A . C. Camargo no período de 1954 a 1995. Em relação aos dados clínicos, houve predomínio do sexo masculino, raça branca e idade entre 46 e 64 anos. Apenas 32 casos (12,16%) foram diagnosticados nos estádios clínicos I e II. O consumo de tabaco, foi encontrado em 77,56% dos casos e 59,69% dos pacientes faziam uso de bebida alcoólica. Na análise univariada de sobrevida global, encontrou-se melhor prognóstico associado aos estádios iniciais, ausência de metástase cervical, sexo feminino e submetidos a tratamento cirúrgico. Na análise multivariada, as variáveis relacionadas ao aumento no risco de óbito, foram sexo masculino e aspecto clínico úlcero-infiltrativo. / Abstract: In the present study 264 cases of squamous cell carcinoma of lower gingiva treated at Centro de Tratamento e Pesquisa-Hospital do Cancer- A . C. Camargo between 1954 to 1995 were evaluated. Concerning the clinical features, there was a predominance of male, white people age 46 to 65 years. Only 32 cases (12,16%) were diagnosed at clinical stage I and II. 77,56% of the cases were tobacco consumers and 59,69% were alcohol drinkers. In the univariate survival rate, a better prognostic was found related to early clinical stage diagnostic, absence of nodal involvement, female cases, and patients treated by surgery. The features related to a higher risk of death with the multivariate analysis were male patients and infiltractive clinical aspect. / Doutor

No description available.