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OBJECTIVE: To present bismuth subgallate as a simplified and efficient method for promoting hemostasis at palatal donor sites, as evaluated by measuring hemostasis time and delayed bleeding. METHOD AND MATERIALS: Ten patients received the bismuth subgallate paste as a topical hemostatic agent, while another 10 patients received moistened gauze pressure. The time to obtain complete hemostasis, defined as no visual bleeding, was recorded for each subject. RESULTS: Bismuth subgallate paste was found to decrease hemostasis time, when compared with moistened gauze pressure. The mean hemostasis time for the bismuth subgallate group was significantly shorter (2.6 +/- 0.7 minutes) when compared to the moistened gauze group (7.2 +/- 1.4 minutes). While delayed bleeding was observed in the moistened gauze group, no statistically significant difference was found between the groups (P = .10). CONCLUSION: The use of bismuth subgallate as a topical hemostatic for palatal wounds may be an option when performing free soft tissue grafts. [ABSTRACT FROM AUTHOR]

Clinical results with acellular dermal matrix graft (ADMG) in periodontal surgeries suggest that the material is incorporated by the host tissues. However, histologic studies of the ADMG incorporation process are limited. The objective of this study was to evaluate the incorporation of ADMG into gingival tissues in a dog model. Gingival recession-type defects were created at the canines of six dogs. After 6 weeks, periodontal surgeries to repair the defects were performed using ADMG. Two animals each were sacrificed after 4, 8, and 12 weeks. At 4 weeks, thick collagen fibers from the ADMG were clearly seen in the connective tissue, and some blood vessels were penetrating into the ADMG. At 8 weeks, blood vessel penetration was enhanced, and collagen fiber bundles from the ADMG were seen sending branches into the connective tissue in all directions. After 12 weeks, the ADMG and the connective tissue seemed to be well integrated into a single highly vascularized structure, indicating almost complete incorporation of the ADMG. [ABSTRACT FROM AUTHOR]

Background and Objective: Chronic kidney disease (CKD) is a complex disorder, which results in several complications involving disturbance of mineral metabolism. Periodontal disease is an infectious disease that appears to be an important cause of systemic inflammation in CKD patients. Periodontal disease is characterized by clinical attachment loss (CAL) caused by alveolar bone resorption around teeth, which may lead to tooth loss. Osteoprotegerin (OPG) is a key regulator of osteoclastogenesis. Polymorphisms are the main source of genetic variation, and single nucleotide polymorphisms (SNPs) have been reported as major modulators of disease susceptibility. The aim of this study was to investigate the association of a polymorphism located at position -223 in the untranslated region of the OPG gene, previously known as -950, with susceptibility to CKD and periodontal disease. Material and Methods: A sample of 224 subjects without and with CKD (in hemodialysis) was divided into groups with and without periodontal disease. The OPG polymorphism was analyzed by polymerase chain reaction and restriction fragment length polymorphism. Results: No association was found between the studied OPG polymorphism and susceptibility to CKD or periodontal disease. Conclusion: It was concluded that polymorphism OPG-223 (C/T) was not associated with CKD and periodontal disease in a Brazilian population. Studies on other polymorphisms in this and other genes of the host response could help to clarify the involvement of bone metabolism mediators in the susceptibility to CKD and periodontal disease. [ABSTRACT FROM AUTHOR]

The objective is to present a clinical case of dental autotransplantation managed with surgery, orthodontics, endodontics, periodontics, and aesthetic rehabilitation. A 10-year-old boy sought treatment after avulsion of the maxillary left central incisor, which was not reimplanted. Based on anamnesis, clinical examination, and complementary examinations, agenesis of the maxillary and mandibular second premolars except the mandibular right second premolar was observed. After a multidisciplinary planning, the space in the maxillary left central incisor region was opened to receive the transplanted mandibular right second premolar. The receptor site was created in a single surgical procedure. Pulp necrosis was noted in the transplanted tooth, which was treated endodontically, and the agenesis spaces were closed using fixed orthodontic appliances. After removing the appliance, gingivectomy with osteotomy was performed in the maxillary right central incisor and the transplanted tooth regions to harmonize the height and shape of the gingival contour. Next, aesthetic readjustment was performed with tooth whitening, using office and home techniques, followed by microabrasion of the vestibular surface of the maxillary right central incisor. Direct composite resin restorations were placed in the maxillary incisors, and the teeth were rehabilitated using incisal and palatal guides. A multidisciplinary approach is essential for reestablishing the function and aesthetics of complex cases involving dental autotransplantation., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Purpose: Subepithelial connective tissue grafts (SCTGs) are commonly performed for the treatment of gingival recession due to their high predictability. This study evaluated and histologically compared connective tissue grafts in terms of the presence of epithelial remnants and composition of the tissue types that were present (epithelium, lamina propria, and submucosa)., Methods: Ten patients underwent epithelium removal using 2 different techniques: the use of a blade (group B) and through abrasion (group A). Twenty samples were collected and each tissue type was analyzed histologically in terms of its area, thickness, and proportion of the total area of the graft., Results: In 4 samples (40%) from group B (n=10) and 2 samples (20%) from group A (n=10), the presence of an epithelial remnant was observed, but the difference between the groups was not statistically significant ( P >0.05). Likewise, no statistically significant differences were observed between the groups regarding the area, mean thickness, or proportion of the total area for any of the tissue types ( P >0.05)., Conclusions: Histologically, SCTGs did not show statistically significant differences in terms of their tissue composition depending on whether they were separated from the epithelial tissue by abrasion or by using a blade., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported., (Copyright © 2020. Korean Academy of Periodontology.)

Introduction: The vitamin D-receptor axis is involved in multiple physiological functions and altered states such as hypertension, mineral metabolism disorders, and inflammation. These disturbances are major risk factors for progression to end-stage kidney disease and cardiovascular disease. In addition, changes in internal systemic environment could be influencing the impact of survival in patients with kidney disease. This study aimed to evaluate the impact of vitamin D receptor (VDR) polymorphisms on hemodialysis patients' survival., Material and Methods: A total of 122 hemodialysis patients and 120 healthy controls were compared for VDR gene polymorphism. Markers for full coverage in the VDR gene were selected and genotyped. The hemodialysis patients were followed until death event, which was considered the primary endpoint for the survival analysis., Results: Two tag SNPs (rs10875695 and rs11168293) showed significant differences between the hemodialysis and healthy patients. In survival analysis, the CC genotype for rs2248098, compared to the TT genotype, was associated with a worse mortality rate. After adjustments for age, sex, diabetes mellitus, and cardiovascular disease, the genotype CC (rs2248098) was associated with a higher risk of mortality in a multivariable analysis., Conclusions: Polymorphisms specific to patients with kidney disease could be influencing different conditions associated with mortality. Thus, these genetic markers, rs2248098 for example, would act in a specific time in the history of kidney disease and would bring different results of patient survival outcomes.

Background and Objective: Interleukin-6 (IL-6) is a powerful stimulator of osteoclast differentiation and bone resorption. Production of IL-6 is modulated by polymorphisms, and higher levels of this cytokine are found locally in patients with chronic periodontitis. In this study we performed a modern approach - Complete physical mapping of the IL6 gene - to identify the polymorphisms associated with chronic periodontitis in a southern Brazilian population sample., Material and Methods: One-hundred and nine individuals of both genders (mean age: 41.5 ± 8.5 years) were divided into a study group (56 participants with periodontitis) and a control group (53 individuals without periodontitis). After collection and purification of DNA, nine tag single nucleotide polymorphisms (SNPs; rs1524107, rs2069835, rs2069837, rs2069838, rs2069840, rs2069842, rs2069843, rs2069845 and rs2069849) covering the entire gene were selected according to the information available on the International HapMap Project website and evaluated using real-time PCR., Results: Differences in the distribution of the following parameters were statistically significant between study and control groups: number of teeth (p = 0.030); probing depth (p < 0.001); clinical attachment level (p < 0.001); gingival index (p < 0.001); plaque index (p = 0.003); calculus index (p < 0.001); and dental mobility (p < 0.001). It was found that marker rs2069837 (located in intron 2 of IL6) under G dominant was associated with protection against chronic periodontitis in a Brazilian population in the presence of clinical variables, such as visible plaque, dentist visit frequency and dental floss use, and was suggested for the first time as a marker of susceptibility to chronic periodontitis., Conclusion: Complete physical mapping of IL6 (using tag SNPs) was carried out for the first time, unveiling allele G of polymorphism rs2069837 (located in the second intron of IL6) as a suggestive marker of protection against chronic periodontitis in a Brazilian population., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This work focused on the process of bone repair of defects in standardized calvaria of Wistar rats treated with biphasic calcium phosphate (BCP), mineral trioxide aggregate (MTA), or a combination of the two. Eighty Wistar rats were divided into four treatment groups and were examined at 2 and 8 weeks. A surgical defect was created in the calvaria using a 6-mm diameter trephine drill. The cavity was treated with BCP, MTA, or BCP+MTA; untreated rats with clot formation served as controls. Samples were evaluated histologically and by immunohistochemical staining for areas of new osteoid tissue and new bone tissue, as well as the percentage of labelled cells using anti-bone morphogenetic protein receptor type 1B (anti-BMPR1B) antibodies. Statistically significant differences were found for all dependent variables (area of new osteoid tissue, area of new bone, and percentage immunostaining) by group (P<0.0001) and time (P<0.0001), and for the interaction of the two (P<0.0001). The MTA group at 8 weeks showed the highest amount of osteoid tissue. The same group also exhibited the highest amount of bone tissue formation. The 2-week MTA samples and 2-week BCP+MTA samples exhibited the highest percentages of stained cells. The best results in terms of the area of osteoid and bone tissue formation and the percentage of BMPR1B were observed for the MTA group, confirming that the combination of BCP+MTA does not result in a significant improvement., (Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Chronic periodontitis (CP) is a continuous, reversible source of inflammation with a potential impact on mortality in patients undergoing hemodialysis (HD). This study investigates the impact of oral health indicators, CP, and its treatment on survival rates in a group of patients undergoing HD., Methods: Clinically stable patients undergoing HD were referred for a dental examination. All patients were prospectively followed in the dialysis clinic, and all-cause mortality was recorded. Three groups of patients were analyzed: those who received CP treatment, those who did not, and patients without CP as a control group., Results: A total of 122 patients (79 males and 43 females, aged 23 to 77 years; mean age: 50 years; range: 23 to 77 years) were enrolled. Forty percent reported having rarely been evaluated by a dentist, and 59% had CP. There were 34 fatal events during a mean follow-up time of 64.1 ± 11.2 months. Oral factors associated with death in the univariate analysis were decreased frequency of dental visits; non-use of dental floss; increased decayed, missing, and filled teeth index; presence of CP; and absence of CP treatment. Patients with CP had a higher risk of death from all causes compared with patients without CP in the univariate analysis for untreated patients (hazard ratio 2.65 [95% confidence interval 1.06 to 6.59]; P = 0.036) and to a lesser extent for treated patients (2.36 [1.01 to 5.59]; P = 0.047). These significant differences were not maintained after adjustments for confounders in the multivariate model., Conclusions: These results suggest that poor oral health, including CP, is a common finding in patients undergoing HD. The results of this study call for intervention trials to test the hypothesis that treatment of CP improves survival in maintenance of patients undergoing HD.

Unlabelled: Chronic kidney disease (CKD) and periodontitis (PD) are complex inflammatory disturbances, influenced by genetic factors. Interleukin (IL)-1 genes code for inflammatory mediators involved in the physiopathogenesis of both diseases. Functional polymorphisms in IL1 genes modulate cytokine levels and have been associated with susceptibility to immune-inflammatory conditions., Objectives: The aim of this study was investigate the association of functional IL1 gene polymorphisms and transcript levels with susceptibility to CKD and PD., Design: The sample consisted of 246 individuals, mean age 44.8 years, divided into: group 1 (64 patients without CKD and without PD), group 2 (58 without CKD and with PD), group 3 (52 with CKD and without PD) and group 4 (72 with CKD and with PD). DNA was obtained from cells of oral mucosa and polymorphisms IL1AC-889T, IL1BC-511T, IL1BC+3954T and IL1RN (intron 2) were analyzed by PCR-RFLP. Transcript levels from gingival tissues were analyzed by real-time PCR., Results: IL1RN(*)1 allele was associated with almost 4-fold increased risk for CKD (OR 3.92 95% CI=1.6-9.4, p=0.002). IL1RN(*)2 allele was associated with 3-fold increased risk for PD in CKD patients (OR 3.08 95% CI=1.2-7.9, p=0.019). Allele T for polymorphism IL1B+3954 was associated with CKD in PD patients (OR 2.28 95% CI=1.1-4.7, p=0.019). Significantly increased levels of transcripts of IL1A, IL1B and IL1RN genes were found in PD patients., Conclusions: It was observed an evidence for association of IL1B and IL1RN alleles with susceptibility to CKD and PD. Higher levels of IL1 gene transcripts were found in PD patients., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Unlabelled: Chronic periodontitis (CP) and end-stage renal disease (ESRD) are complex inflammatory conditions. Higher levels of MMP-1 were found in fluids and gingival tissues from CP patients and in the blood and tissues from ESRD patients. MMP1-1607 (1G/2G) is a functional polymorphism, as it alters MMP-1 expression., Objective: The aim of this study was to investigate the association of the MMP1-1607 (1G/2G) polymorphism with CP and ESRD and evaluate differences in transcript levels between the groups., Design: A total of 254 individuals were divided into four groups: Group 1, without CP and without chronic kidney disease (CKD) (n = 67); Group 2, with CP and without CKD (n = 60); Group 3, without CP and with CKD stage 5 (ESRD) (n = 52), and Group 4, with CP and with ESRD (n = 75). The MMP1-1607 polymorphism was analysed by PCR-RFLP. MMP1 gene transcripts from gingival tissues were analysed by real-time PCR., Results: No association was found between the MMP1-1607 polymorphism and CP or ESRD. Increased levels of MMP1 transcripts were observed in CP patients with or without ESRD. No differences were observed in the transcript levels according to the genotypes., Conclusion: It was concluded that the MMP1-1607 polymorphism was not associated with either CP or ESRD. However, higher levels of MMP1 gene transcripts were found at gingival sites of CP in patients both with and without ESRD., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

A multidisciplinary treatment of a case of subgingival fracture in a maxillary anterior tooth is presented. This case report describes a simple method involving an interocclusal appliance and an elastic band for rapid orthodontic extrusion to reestablish biologic width. In addition, a simple technique for surgical recontouring following the coronal displacement of the gingival margin prior to restoration of fractured tooth is explained.

A multidisciplinary therapy used to treat a patient with a severe mucogingival deformity in the area of maxillary anterior teeth is presented. The simple technique uses an interocclusal appliance and elastic band for orthodontic extrusion to correct the mucogingival deformity and develop an implant site. This approach is designed to increase the amount of keratinized tissue and new alveolar bone, which are necessary for the development of an implant site. Clinical and radiographic examinations at the 5-year follow-up revealed a successful tooth replacement and improved esthetic appearance that was achieved with multidisciplinary treatment. The advantages and disadvantages of this technique are discussed., (Copyright © 2011 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Background: The aim of the present study is to evaluate the use of anorganic bovine bone (ABB) associated with a collagen membrane (CM) for a sinus graft by means of clinical, histologic, and radiographic parameters in cases with bone availability < or =7 mm. A preliminary evaluation consisted of a clinical examination, computed tomography (CT), and a panoramic x-ray., Methods: Ninety-two patients requiring bilateral sinus grafts and 222 requiring unilateral procedures (total: 406 sinuses) participated in this study. A total of 1,025 implants were placed in the grafted sinuses. A total of 118 implants were placed simultaneously with the sinus graft (one stage), and 907 implants were placed in a subsequent surgery (two stages), 6 to 12 months after the graft was performed. In seven cases, a biopsy was harvested for histomorphometric analysis. Recall appointments were scheduled every 6 months, and panoramic and periapical x-rays were required every year for 3 years., Results: Among 1,025 implants, 19 were lost (survival rate: 98.1%). The difference in survival rates for implants placed in native bone < or =3 mm (98.1%), >3 to < or =5 mm (98.6%), and >5 to < or =7 mm (97.0%) was not statistically significant (P = 0.3408). The survival rates for implants with rough and machined surfaces (98.6% and 97.0%, respectively) were not statistically significant (P = 0.0840). The histomorphometric analysis showed new bone formation (39.0% +/- 12%), marrow space (52.9% +/- 9.3%), and residual ABB (8% +/- 2.7%)., Conclusion: Our results indicated that 1,025 implants placed in sinuses grafted exclusively with ABB combined with CM led to an excellent and predictable survival rate of 98.1%.

Background: Poor oral health status may have an impact on the health status of patients with chronic renal failure., Aim: To describe the oral health status of a group of Brazilian patients with chronic renal failure., Material and Methods: Retrospective review of the medical records of patients with chronic renal failure, of whom 13 (4.5%) were in a predialysis stage, 158 (55%) were on hemodialysis, 23 (8.4%) were on peritoneal dialysis and 92 (32.1%) were transplanted. General oral health, presence of dental calculus, and halitosis were recorded. The number of decayed, missed and filled teeth was analyzed by means of DMF-T (Decayed, Missed and Filled Teeth) index., Results: The sample was composed of 152 men (53%) and 134 women (47%), aged 42+/-13 years. Oral health status was considered defective in most patients (83%). Eighty-seven percent had dental calculus and 55% had halitosis. Transplant patients reported significantly less halitosis (40.2%) than the rest of the groups. The DMF-T for the whole population was 20.6 and had a positive correlation with age., Conclusions: This group of patients with chronic renal failure presented a poor oral health status. Dental treatment programs for these patients should be implemented to avoid the exposure to dental pathogens.

Background/aims: Chronic kidney disease (CKD) and periodontitis (PD) are serious public-health concerns. Vitamin D is a fat-soluble steroid hormone that interacts with its nuclear receptor (VDR) to regulate a variety of biological processes, such as bone metabolism, immune response modulation and transcription of several genes involved in CKD and PD disease mechanisms. The aim of this work was to investigate the association between polymorphisms in the VDR gene and end-stage renal disease (ESRD) and PD., Methods: 222 subjects with and without ESRD (in hemodialysis) were divided into groups with and without PD. Polymorphisms TaqI and BsmI in the VDR gene were analyzed by PCR restriction fragment length polymorphism. The significance of differences in allele, genotype and haplotype frequencies between groups was assessed by the chi2 test (p value <0.05) and odds ratio (OR)., Results: Allele G was associated with protection against ESRD: groups without versus with ESRD (GG) x (GA+AA): OR = 2.5, 95% CI = 1.4-4.6, p = 0.00; (G x A): OR = 1.5, 95% CI = 1.0-2.3, p = 0.02; (TG + CG) x (TA + CA): OR = 1.5, 95% CI = 1.0-2.3, p = 0.02. No association was observed between the study polymorphisms and susceptibility to or protection against PD., Conclusion: Allele G of the VDR BsmI polymorphism was associated with protection against ESRD., (2007 S. Karger AG, Basel)

Background: Anatomic characteristics of interproximal areas are dependent on the anatomy, position, and proximal contact of adjacent teeth. The objective of this study was to investigate the influence of the reestablishment of the interproximal contact following the restorative alveolar interface (RAI) procedure on the interproximal gingival COL and formation of the interdental gingival papilla., Methods: Six mongrel dogs received bilateral apically positioned flaps, crown lengthening, and the RAI procedure on the maxillary fourth bicuspid and first molar. After 2 weeks, in a randomized manner, one side was prepared to receive metallic crowns and the opposite side remained as the control. The crowns were cemented at the 4-week postoperative period, and the dogs were sacrificed after another 4 weeks, totaling a period of 4 weeks with the full crowns in position and a total of 8 postoperative weeks. Histologic specimens were stained with hematoxylin and eosin and Mallory dyes. Sections 6 micro m thick were obtained in a bucco-lingual plane allowing ample visualization of the interproximal area., Results: Clinical measurements revealed that, in the restored sides, four animals had complete fill of the interdental spaces with gingival papilla, whereas the other two dogs had a distance from the contact point to the tip of papilla varying from 0.02 to 0.021 mm. In the control group, papillae were totally reepithelialized with keratinized epithelium and a convex form. The epithelium completely covered the connective tissue and showed both epithelial projections and surface desquamation. On the test group, despite the presence of the prosthesis, the COL morphology modified by preprosthetic surgery was not altered, presenting a convex papilla with a triangular form and with a keratinized epithelium. Additional histologic characteristics were the same as found in the control group., Conclusion: Based on the results of this study, the reestablishment of the contact point does not revert what was obtained with the RAI procedure; the interproximal tissues remain convex and keratinized.

The aim of this study was to evaluate the role of acellular dermal matrix graft (ADMG) acting as a membrane, associated with a resorbable hydroxyapatite (RHA) in bone regeneration to prevent ridge deformities after tooth extraction. Fifteen patients who had at least 2 noncontiguous, uniradicular teeth indicated for extraction were selected. In group I, the extraction sockets were covered by ADMG alone; and in group II, the alveoli were filled with RHA before the placement of the ADMG. After 6 months, re-entry surgeries and biopsies were performed. Although ridge thickness had been preserved in both groups, the means were significantly greater (P < 0.05) for group II when compared to group I (6,8 +/- 1.26 and 5.53 +/- 1.06). The histologic analysis showed small bone formation in some samples for group II, where the presence of a highly vascularized fibrous connective tissue surrounding the particles was a common finding. Based on the results, it can be concluded that the ADMG was able to preserve ridge thickness and that the additional use of RHA favored the preservation of the ridges along with an increase in the width of keratinized tissue.

A buccal plate destroyed as a result of a longitudinal root fracture was completely restored by the use of a Frialit-2 implant placed in the alveolus of the fractured maxillary left first bicuspid. An acellular dermal matrix material was used as a membrane barrier to cover the implant, and a bioactive glass was used as grafting material. After 6 months, the defect around the implant was completely filled by mineralized tissue.