Prevotella intermedia/nigrescens group bacteria are Gram-negative, non-motile, anaerobic rods abundant in the subgingival microbiome of human periodontitis patients, and relatively sparse in persons with periodontal health. P. intermedia/nigrescens may be inadequately suppressed in periodontal pockets with conventional mechanical-surgical forms of periodontal therapy. Therefore, short-term systemic antibiotic therapy is often recommended in the treatment of recalcitrant (refractory) severe periodontitis patients where high numbers of P. intermedia/nigrescens persist in the subgingival microbiota. Limited available data suggests that the antibiotic sensitivity profile of periodontal P. intermedia/nigrescens has changed over time among severe periodontitis patients in the United States, with increasing levels of antibiotic resistance reported. These findings have potentially important clinical implications for dental professionals and their severe periodontitis patients which need further confirmation and clarification. To further expand knowledge on this clinically relevant issue, the purpose of the present study was to determine and compare over a 10-year period (2011 versus 2021) the prevalence of in vitro resistance of periodontal P. intermedia/nigrescens to the antibiotics amoxicillin, metronidazole, clindamycin, and doxycycline. / Oral Biology

The research presented in this thesis focuses on understanding the biomechanical effects of various cranial features that are often ignored in finite element models (FEMs) because their size, position, and complex shapes make them difficult to model. Specifically, this work examines the effects of the alveoli (tooth sockets), periodontal ligament, and squamosal suture on the stress and strain distributions in a cranium under masticatory and dynamic tooth loads. Results from this research will help determine if these features have a significant effect on stress and strain patterns and will yield guidelines as to if or under what conditions they need to be modeled in future FE skull model analyses. As part of this research, three sets of FEMs were developed to address a hypothesis focusing on each cranial feature. The first set of models examined the effect of the tooth sockets on the stress and strain distributions in a cranium under static biting conditions to determine if improperly modeled sockets produce strong global effects in craniofacial regions. The second set of models were used to assess the effect of the PDL's material behavior on the stresses and strains in a cranium under static biting and dynamic tooth loading conditions to determine if the PDL plays an important role in reducing stresses and strains in a model. The final set of models were used to determine the effect of the squamosal suture size on the stresses and strain energies in a cranium under static biting conditions to see if an increase in suture size decreases the risk of separation of the temporal bone from the parietal bone. Results for all analyses indicate the effects of the cranial features are local (i.e. within the vicinity of the feature), with no meaningful global effects. This suggests the sockets, PDL, and squamosal suture do not play an important role in global stress and strain distributions in a cranium under masticatory and dynamic tooth loads. Therefore, it may be safe to ignore the sockets, PDLs, and squamosal sutures during the FE modeling process if the objective of the analysis is to understand global stress and strain patterns.

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Frailty is defined as a biological syndrome marked by reduced physiological reserve and heightened vulnerability to stressors, leading to adverse health outcomes like dependency, functional impairment, cognitive decline, and mortality. While various conditions have been associated with frailty, oral health is one of them. However, the precise relationship and the underlying pathways through which oral health conditions may be associated with frailty remain unclear. Limitations such as small sample sizes, inadequate control for confounders, inconsistent results across studies, and variations in frailty assessment methods have contributed to the inconclusiveness of this relationship. Considering these limitations, this dissertation intends to address them by using a rigorous cohort with a robust design, which will allow for a larger sample size, appropriate confounder assessment, and the opportunity to create a practical frailty index (FI) using data from this cohort. This approach enables a comprehensive investigation of the association between clinical, functional, and microbiological oral health and frailty, both cross-sectionally and longitudinally (12 years of follow-up). Furthermore, this study aims to conduct an initial exploration of the mediating effects of inflammatory biomarkers in this relationship.Three specific aims were pursued to achieve this goal. Firstly, a systematic review was conducted to critically summarize the existing evidence on the association between poor oral health and frailty, assessed through any frailty index instrument. Subsequently, two analytical aims were undertaken to delve into the association between oral health and frailty. The initial analytical aim comprised two parts. The first part focused on creating and validating a population frailty index score using data from the Oral Infections and Vascular Disease Epidemiology Study (INVEST). The second part aimed to investigate, cross-sectionally, whether poor oral health independent of factors such as sex, age, occupation, educational level, marital status, and smoking is positively associated with frailty. Additionally, the study aimed to test the robustness and replicability of both the FI and the cross-sectional relationship, utilizing a smaller set of oral data from the Chilean National Health Survey conducted in 2016-2017. The second analytical aim was to explore the prospective association between oral health – assessed clinically, functionally, and microbiologically- and frailty, using the INVEST cohort with its 12 years of follow-up and repeated measures for the exposure, confounders and outcome. As a secondary aim, we explored the mediating effects of select inflammatory biomarkers in this relationship. The systematic review identified 11 studies that investigated the relationship between oral health and frailty, utilizing the FI as an instrument for assessing frailty. All these studies were cross-sectional, and the FI employed in them encompassed a range of deficits, varying from 32 to 76 items. The most frequently incorporated constructs in the frailty index were comorbidities, cognitive impairment, activities of daily living (ADL and/or IADL), functional limitations or abilities, anthropometry, depressive symptoms, and self-reported health status. In terms of the association between oral health and frailty, the review showed that a lower number of teeth, poor self-reported oral health, and experiencing chewing or oral cavity pain were associated with an increased likelihood of frailty, as indicated by any FI. Notably, no studies reported an association between periodontal disease, cavities, use of dental prostheses, and frailty. The second aim showed that within the U.S. population, functional oral health (assessed as the number of teeth and higher number of occlusive tooth pairs) was associated with frailty. Similarly, among the Chilean population aged 55 years and older, frailty was also associated with functional oral health (lower number of additional teeth, wearing dental prostheses, and not having a functional dentition). This study also showed that the inclusion of periodontal microbiota in the regression models improved the model’s fit, suggesting that this microbiota may play a role in the association between oral health and frailty. Finally, the third aim showed that after 12 years of follow-up, a higher incidence of frailty was associated with functional and clinical oral health. In fact, people who exhibited a lower number of additional teeth, had less than 21 teeth, wearing complete dental prostheses, and had periodontal disease had a higher incidence of frailty. Moreover, CRP, IL-6, and TNF- exhibited small, but not statistically significant, effects as potential mediators between oral health and frailty. These findings suggest the potential for further research to explore the action of other inflammatory biomarkers and pathways through which oral health may be associated with frailty.

Orientador: Sérgio Lucio Pereira de Castro Lopes / Resumo: O objetivo deste estudo foi comparar as possíveis alterações em parâmetros geométricos dimensionais das lesões de furca em molares superiores - área máxima de abertura da lesão (AMA), as angulações formadas entre as raízes (ANG), o volume e densidade da lesão (VDL) e a presença e altura de defeitos infraósseos relacionados com a lesão (DIO) – obtidos em imagens por tomografia computadorizada de feixe cônico (TCFC), de pacientes acometidos por periodontite grau C, após a terapia regenerativa com a utilização de proteínas derivadas da matriz do esmalte (EMD). Para tal, foram estudados 02 grupos: controle (cirurgia) (n=17) e grupo teste (cirurgia+EMD) (n=17). Adicionalmente, foi estudada a correlação entre os parâmetros e o sucesso da terapia adotada, avaliando-se a redução da profundidade de sondagem (∆PS) e o ganho do nível de inserção clínica horizontal (∆NICH). Utilizou-se os softwares OnDemand3D (Cybermed, Seul, Coréia do Sul) e itk-SNAP 3.4.0 (University of North Carolina, Chapel Hill, NC, EUA) para avaliação das imagens de TCFC. Para análise das características demográficas foram realizados Teste T, Mann-Whitney Rank Sum Test e Qui-Quadrado, indicando não haver diferenças estatísticas entre idade, número de dentes analisados e sexo (p>0,05). Os testes ANOVA e Teste T foram aplicados no intuito de estudar os parâmetros clínicos (∆PS e ∆NICH) no baseline e após 06 meses de tratamento nos dois grupos, não sendo observadas diferenças estatisticamente significantes entre os gr... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The objective of this study is to compare the possible changes on geometric dimensional parameters of furcation lesions in maxillary molars - maximum area of lesion opening (AMO), angulations formed between roots (ANG), volume and density of the lesion (VDL) and the presence and height of lesion-related infra-osseous defects (DIO) - obtained on cone beam computed tomography (CBCT) images of patients with grade C periodontitis after regenerative therapy using enamel matrix derivative proteins (EMD). To this end, 02 groups were analyzed: control (surgery) (n = 17) and test group (surgery + EMD) (n = 17). Additionally, the correlation between the parameters and the success of the adopted therapy was studied, and the reduction of the depth pocket (ΔPD) and the relative horizontal clinical attachment level (ΔHCAL) were evaluated. Both software OnDemand3D (Cybermed, Seoul, South Korea) and the itk-SNAP 3.4.0 (University of North Carolina, Chapel Hill, NC, USA) were used to evaluate the CBCT images. In order to analyze the demographic characteristics, Mann-Whitney Rank Sum Test and Chi-Square were used, indicating that there were no statistical differences between age, number of teeth analyzed and gender (p> 0.05). The ANOVA and T-tests were applied in order to study the clinical parameters (ΔPD and ΔHCAL) at the baseline and after 06 months of treatment in both groups, no statistically significant differences were observed between the groups in both times (p > 0.05). The Pearson’s ... (Complete abstract click electronic access below) / Mestre

A periodontite agressiva (PA) é uma doença que acomete uma população mais jovem, com aspectos clínicos e radiográficos característicos. Possui 2 formas de apresentação: localizada (PAL) e generalizada (PAG) que apresentam padrões distintos. É uma doença que pode provocar perdas dentárias precocemente, levando ao comprometimento estético, funcional e social. É fundamental que se estabeleça um programa adequado de manutenção periodontal (MP) após o tratamento, para impedir ou retardar a progressão da doença. Os objetivos desse estudo foram avaliar os parâmetros clínicos periodontais: profundidade clínica de sondagem (PCS), nível clínico de inserção (NCI), sangramento à sondagem (SS), mobilidade e perda dentária, de 39 pacientes, por um período de 5 anos (realizando as avaliações no início, 1 ano, 3 anos e 5 anos após a conclusão do tratamento ativo, que consistiu de tratamento mecânico - raspagem e alisamento radicular - orientação de higiene bucal e antibioticoterapia - metronidazol e amoxicilina). As consultas de MP foram feitas trimestralmente durante os 5 anos. Como conclusão verificou-se uma melhora dos parâmetros clínicos periodontais em ambos os grupos, bem como, uma pequena quantidade de dentes extraídos por motivos periodontais (5%), mostrando a efetividade do tratamento e das consultas de MP. / Aggressive periodontitis (AP) is a disease that affects a younger people, with typical clinical and radiographic aspects. It has 2 forms of presentation: localized (LAP) and generalized (GAP) which have different patterns. It is a disease which can cause early tooth loss, induce to aesthetic, functional and social impairment. It is decisive that an appropriate periodontal maintenance (PM) program be established after treatment to prevent or delay the progression of the disease. The aim of this study was to evaluate the periodontal clinical parameters: probing of depth (PD), clinical attachment level (CAL), bleeding on probing (BoP), mobility, tooth loss, of 39 patients, for a period of 5 years ( performing evaluation on baseline, 1 year, 3 years and 5 years after the end of the active treatment, which consisted of mechanical treatment - scaling and root planning - oral hygiene orientation and antibiotic therapy - metronidazole and amoxicillin). PM appointments were made quarterly during the 5 years. As conclusion, there was an improvement in periodontal clinical parameters in both groups, as well as, a small quantity of teeth extracted by periodontal causes (5%), showing the effectiveness of the treatment and the PM appointments.

Os objetivos desse estudo foram comparar a condição periodontal de dentes pilares e não pilares dos indivíduos reabilitados com prótese parcial removível e avaliar o impacto na qualidade de vida de indivíduos parcialmente endêntulos, após o uso da PPR. As comparações entre os dois grupos para medidas quantitativas foram feitas através do teste não paramétrico de Wilcoxon, pois os dados não tiveram distribuição normal. Para medidas qualitativas foi utilizado o teste de Wilcoxon. Em todos os testes foi adotado nível de significância de 5%. Foram avaliados 113 dentes pilares de e 122 dentes não pilares. Dos dentes não pilares, 49 se localizavam em maxila e 73 em mandíbula. Dos dentes pilares, 61 se localizava em maxila e 52 em mandíbula. Os parâmetros avaliados foram profundidade de sondagem, nível de inserção clínica, índice gengival, índice de placa, recessão gengival, condições de higiene da prótese, quantidade de mucosa ceratinizada, classificação da área desdentada segundo Kennedy, tipo de grampo utilizado, influência da condição oral na qualidade de vida. A média de uso da PPR em dentes não pilares foi de 6,25 anos com desvio padrão de 3,592. A média de uso de PPR em dentes pilares foi de 7,15 anos com desvio padrão de 3,869. Em todas as médias de profundidade de sondagem os dentes pilares apresentaram maior resultado, mostrando diferenças estatisticamente significantes. Em todas as médias de nível de inserção clínica os dentes pilares apresentaram maior resultado e diferenças estatisticamente significantes. Resultados quanto ao índice gengival não mostram diferenças estatísticas. Dentes pilares apresentam uma maior incidência em scores mais altos do índice de placa, mas não foi encontrada diferença estatisticamente significante. A quantidade de mucosa ceratinizada para dentes não pilares, medida em mm, foi em média 2,70, com desvio padrão de 1,271. A quantidade de mucosa ceratinizada para dentes pilares, medida em mm, foi em média 2,66, com desvio padrão de 1,207. Resultados quanto a quantidade de mucosa queratinizada não mostram diferenças estatísticas. Dentes pilares mostram menor incidência de dentes sem recessão e maior incidência de dentes com recessões, porém não se encontrou diferenças estatísticas. As médias de profundidade de sondagem e nível de inserção clínica dos dentes pilares em relação aos tipos de grampos foram maiores com grampos de ação abraçamento. Próteses instaladas em arcos do tipo I mostraram maior índice de Tarbet. O impacto do uso de PPR na qualidade de vida foi fraco. A comparação dos parâmetros clínicos dos dentes pilares e não pilares mostrou diferenças estatísticas apenas para os parâmetros clínicos de profundidade de sondagem e nível de inserção clínica; as médias de profundidade de sondagem e nível de inserção clínica dos dentes pilares em relação aos tipos de grampos foram maiores com grampos de ação abraçamento; próteses instaladas em arcos do tipo I mostraram maior índice de Tarbet; impacto na qualidade de vida da prótese parcial removível foi fraco. / The aim of this study was compare the periodontal condition of abutment and nonabutment teeth of individuals rehabilitated with removable partial denture and evaluate the impact on quality of life of individuals after using the RPD. The comparisons between the two groups for quantitative measurements were made using the Wilcoxon nonparametric test, since the data were not normally distributed. For qualitative measures the Wilcoxon\'s test was used. For all tests the significance level of 5% was used. It were evaluated 113 abutment teeth of RPD and 122 non-abutment teeth. 61 abutment teeth were maxillary and 52 were mandibular; 49 non-abutment teeth were maxillary and 73 were mandibular. The parameters evaluated were probing depth, clinical attachment level, gingival index, plaque index, gingival recession, hygiene conditions, quantity of keratinized mucosa, classification according to Kennedy, type of clasp used, influence of oral condition on quality of life. The average use of RDP of non-abutment teeth was 6,25 years with SD of 3,592. The average use of RDP of abutment teeth was 7,15 years with SD of 3,869. Abutment teeth had higher averages of probing depth and clinical attachment level, showing statistically significant differences. Gingival index and plaque index did not show differences between groups. The average quantity of keratinized mucosa for non-abutment teeth, in mm, were 2,70 with SD 1,271. The average quantity of keratinized mucosa for abutment teeth, in mm, were 2,66 with SD 1,207. It didt have significant differences. Abutment teeth had higher incidence of gingival recession, but it wasnt significant differences. RPD did not influence the quality of life. There was no statistically significant difference between the abutment teeth and not-abutment teeth except for probing depth and clinical the attachment level. Prothesis of Class I of Kennedy had higher levels of Tarbet index. RPD had no influence in quality of life.

Estudos sugerem que a periodontite possa ser um fator de risco para o início, desenvolvimento e desfecho da aterosclerose, por meio de mecanismos bacterianos e imunoinflamatórios. Objetivo: Avaliar a influência do tratamento periodontal (TP) em pacientes com doença arterial obstrutiva periférica (DAOP) e periodontite, correlacionando o perfil inflamatório apresentado por esses pacientes após o TP. Materiais e Métodos: Parâmetros clínicos periodontais (índice de placa IP, índice gengival IG, profundidade de sondagem PS, nível clínico de inserção NCI), e os marcadores imunológicos IL-1β, TNF, IL-6, IL-17, IFN-γ, MMP-8, V-CAM-1 e E-selectina foram analisados em fluido crevicular gengival (FCG) e soro desses pacientes (DAOP/DP) (n=25) após TP completo. As amostras de FCG foram coletadas em 3 tempos: no baseline, 45 e 90 dias após o tratamento e de soro nos tempos: baseline e 90 dias. Após reavaliação do tratamento periodontal não cirúrgico, aos 45 dias, foi realizado a o tratamento cirúrgico nos pacientes que apresentaram bolsas residuais 5 mm. Os parâmetros hematológicos de glicemia em jejum, hemoglobina glicada, triglicérides, colesterol total e frações em sangue periférico foram obtidos no baseline e aos 90 dias. Um grupo com DAOP, mas sem doença periodontal (DAOP) (n=15) foi conduzido, em paralelo, para verificação do padrão de melhora. Resultados: Não foram encontradas reduções significativas no perfil lipídico, glicêmico e inflamatório após o TP nos períodos analisados (p > 0.05). No entanto, observou-se correlação moderada positiva aos 45 dias, do NCI em relação aos níveis de 1Lη (r=0,532; p=0,0157) e aos 90 dias, entre o NCI e IL-17 (r=0,501; p=0,0243), ambas no FCG. No soro também foi observada correlação positiva moderada entre a redução do NCI e diminuição da MMP-8 (r=0,621; p=0,0035) aos 90 dias. Conclusão: O TP repercutiu na redução local das citocinas inflamatórias relacionadas à doença periodontal e na redução sistêmica da MMP-8, que é um mediador importante no processo de ruptura das placas ateroscleróticas / Several studies suggest that periodontitis may be a risk factor for the onset and development of atherosclerosis, through bacterial and immunological mechanisms. Objective: To evaluate the influence of periodontal treatment (PT) in patients with peripheral arterial disease (PAD) and periodontitis and to correlate the inflammatory profile presented by these patients after PT. Materials and Methods: Periodontal clinical parameters (plaque index - PI, gingival index - GI, probing depth - PD, clinical attachment level - CAL) and immunological parameters IL-1β, TNF, IL-6, IL-17 , IFN-γ, MMP-8, V-CAM-1 and E-selectin were analyzed in gingival crevicular fluid (GCF) and serum of these patients (PAD /PD) (n = 25) after complete PT. The GCF samples were collected in 3 times: baseline, 45 and 90 days after treatment and serum at baseline and 90 days. After reassessment of the non-surgical periodontal treatment, at 45 days, the surgical treatment was performed in patients with residual pockets 5 mm. Hematologic parameters of fasting glycemia, glycated hemoglobin, triglycerides, total cholesterol, LDL cholesterol and HDL in peripheral blood were obtained at the baseline and 90 days. A group with PAD, but without periodontal disease (PAD) (n = 15) was conducted in parallel to verify the improvement pattern. Results: There were no significant reductions in the lipid, glycemic and inflammatory profile after PT in the analyzed periods (p> 0.05). However, a moderate positive correlation was observed at 45 days for CAL in relation to the GCF levels of 1L-1 (r = 0.532, p = 0.0157) and between the CAL at 90 days of IL-17 (r = 0.501, p = 0.0243). Moderate positive correlation was also observed in the serum between the reduction of CAL and decrease of MMP-8 (r = 0.621; p = 0.0035) at 90 days. Conclusion: PT has repercussions on the local reduction of inflammatory cytokines related to periodontal disease and on the systemic reduction of MMP-8, which is an important mediator in the process of atherosclerotic plaque rupture