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Dilson Palhares Ferreira,1,&ast; Claudia Vicari Bolognani,2,3,&ast; Levy Aniceto Santana,2,&ast; Sergio Eduardo Soares Fernandes,2,3,&ast; Matheus Serwy Fiuza de Moraes,3,&ast; Luana Argollo Souza Fernandes,3,&ast; Daniella Queiroz de Oliveira,3,&ast; Rosália Bezerra de Santana,3,&ast; Leila Bernarda Donato Gottems,2,3,&ast; Fabio Ferreira Amorim1– 4,&ast; 1Graduation Program in Health Sciences, University of Brasília (Unb), Brasília, Brazil; 2Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil; 3Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil; 4Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil&ast;These authors contributed equally to this workCorrespondence: Fabio Ferreira Amorim; Dilson Palhares Ferreira, Graduation Program in Health Sciences, University of Brasília (UnB), Faculty of Health Sciences Campus University Darcy Ribeiro S/N - Asa Norte, Federal District, Brasília, CEP: 70910-900, Brazil, Email ffamorim@gmail.com; palhares.dilson@gmail.comPurpose: The COVID-19 pandemic posed a worldwide challenge, leading to radical changes in surgical services. The primary objective of the study was to assess the impact of COVID-19 on elective and emergency surgeries in a Brazilian metropolitan area. The secondary objective was to compare the postoperative hospital mortality before and during the pandemic.Patients and Methods: Time-series cohort study including data of all patients admitted for elective or emergency surgery at the hospitals in the Public Health System of Federal District, Brazil, between March 2018 and February 2022, using data extracted from the Hospital Information System of Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. A causal impact analysis was used to evaluate the impact of COVID-19 on elective and emergency surgeries and hospital mortality.Results: There were 174,473 surgeries during the study period. There was a reduction in overall (absolute effect per week: − 227.5; 95% CI: − 307.0 to − 149.0), elective (absolute effect per week: − 170.9; 95% CI: − 232.8 to − 112.0), and emergency (absolute effect per week: − 57.7; 95% CI: − 87.5 to − 27.7) surgeries during the COVID-19 period. Comparing the surgeries performed before and after the COVID-19 onset, there was an increase in emergency surgeries (53.0% vs 68.8%, P < 0.001) and no significant hospital length of stay (P = 0.112). The effect of the COVID-19 pandemic on postoperative hospital mortality was not statistically significant (absolute effect per week: 2.1, 95% CI: − 0.01 to 4.2).Conclusion: Our study showed a reduction in elective and emergency surgeries during the COVID-19 pandemic, possibly due to disruptions in surgical services. These findings highlight that it is crucial to implement effective strategies to prevent the accumulation of surgical waiting lists in times of crisis and improve outcomes for surgical patients.Keywords: COVID-19, surgical procedures, operative, elective surgical procedures, acute care surgery, hospital mortality

Mônica Diuana Calasans-Maia,1 Carlos Alberto Brazil Barboza Junior,2 Carlos Alberto Soriano-Souza,3 Adriana Terezinha Neves Novellino Alves,4 Marcelo Jose de Pinheiro Uzeda,1 Victor R Martinez-Zelaya,3 Elena Mavropoulos,3 Maria Helena Rocha Leão,5 Ronaldo Barcellos de Santana,2 Jose Mauro Granjeiro,1 Alexandre Malta Rossi31Clinical Research in Dentistry Laboratory, School of Dentistry, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil; 2Department of Periodontology, School of Dentistry, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil; 3Department of Condensed Matter, Applied Physics and Nanoscience, Brazilian Center for Research in Physics, Rio de Janeiro, Brazil; 4Department of Stomatology. School of Dentistry, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil; 5Department of Biochemical Engineering, School of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, BrazilBackground and objective: Tetracycline and its derivatives, combined with calcium phosphates, have been proposed as a delivery system to control inflammatory processes and chronic infections. The objective of this study was to evaluate the microspheres of alginate encapsulated minocycline-loaded nanocrystalline carbonated hydroxyapatite (CHAMINO) as a biomimetic device to carry out target-controlled drug delivery for alveolar bone repair.Methods: CHAMINO microspheres were implanted in a rat central incisor socket after 7 and 42 days. New bone was formed in both groups between 7 and 42 days of implantation. However, the bone growth was significantly higher for the CHAMINO microspheres.Results: The minocycline (MINO) loading capacity of the nanocrystaline carbonated hydroxyapatite (CHA) nanoparticles was 25.1±2.2 μg MINO/mg CHA for adsorption over 24 hrs. The alginate microspheres containing minocycline-loaded CHA were biologically active and inhibited the Enterococcus faecalis culture growth for up to seven days of the MINO release. An osteoblastic cell viability assay based on the resazurin reduction was conducted after the cells were exposed to the CHAMINO powder and CHAMINO microspheres. Thus, it was found that the alginate extracts encapsulated the minocycline-loaded CHA microspheres and did not affect the osteoblastic cell viability, while the minocycline-doped CHA powder reduced the cell viability by 90%.Conclusion: This study concluded that the alginate microspheres encapsulating the minocycline-loaded nanocrystalline carbonated hydroxyapatite exhibited combined antibacterial activity against Enterococcus faecalis with cytocompatibility and osteoconduction properties. The significant improvement in the new bone formation after 42 days of implantation suggests that the CHAMINO microsphere has potential in clinical applications of bone regeneration.Keywords: nanomaterials, carbonated hydroxyapatite, minocycline, biocompatibility, bone regeneration

Purpose: Soft tissue closure is mandatory for optimal healing of extraction sites treated via guided bone regeneration. The objective of this study was to evaluate the efficacy of a flap design based on the extension of palatal tissues to obtain and maintain soft tissue coverage over grafted extraction sockets. MaterIals and Methods: Adult patients (n = 22) with at least two teeth indicated for extraction were treated. After atraumatic extraction, control sockets were filled with a composite graft (1:1) containing demineralized freeze-dried bone allografts and Bio-Oss. Experimental sockets were treated identically, except that an Atrisorb absorbable barrier membrane was also placed over the graft material before flap closure, which was obtained, in all sockets, by the coronal extension of a vascularized pedicle dissected from the periosteal aspect of the palate. Results: Primary tension-free wound closure was achieved at all treated sites. Exfoliation of the graft material during healing was not observed in either treatment group. High levels of soft tissue closure were maintained throughout the study period for both treatment groups, and membrane exposure was observed in only 7% of treated sites. Conclusion: On the basis of this study it appears that the reported technique was an adequate method of achieving and maintaining complete soft tissue coverage and promoting healing by primary intention in grafted extraction sockets in humans. [ABSTRACT FROM AUTHOR]

Background: Drug-induced gingival enlargement (DIGE) is a common side effect of medications such as anticonvulsants, calcium channel blockers, and immunosuppressants. The treatment of choice for the condition is drug withdrawal or substitution in combination with the nonsurgical phase. In some cases, additional internal or external bevel gingivectomy is needed to achieve periodontal health. Special approaches may be needed in severe DIGE cases superimposed on periodontitis. The aim of this report is to describe the dual-flap internal gingivectomy (DFIG) approach for the simultaneous management of soft and hard tissues via the simultaneous reduction of the connective tissue bulkiness from the superficial flap and preservation of keratinized tissues., Methods: A generalized Stage IV grade C periodontitis with DIGE was treated.  An initial partial thickness flap was elevated and thinned out to a thickness of 1.0-1.5 mm. Then, a second partial-thickness flap was raised, and a thick band of connective tissue was removed. Proper positioning of the primary flap onto the periosteum was obtained and flap adaptation was achieved with localized gingivoplasty., Results: Healthy soft tissue was developed with DFIG by debulking the enlarged connective tissues and apical gingival margin positioning with a predictable wide band of keratinized attached gingiva was achieved.    CONCLUSIONS: The DFIG surgical approach provides adequate access for root instrumentation and preserves KT width. The procedure effectively reduces soft tissue thickness and improves soft tissue contours, in DIGE cases superimposed to periodontitis., Key Points: Gingival enlargement is related to excessive production and deposition of collagen in the inner layer of the connective tissue and the surface of the alveolar bone. The dual-flap internal gingivectomy (DFIG) approach allows for targeted excision of the inner layer of the connective tissue from the buccal primary flap while preserving the width of the keratinized tissue. Adequate soft tissue contours and volume are obtained following the DFIG procedure., (© 2024 American Academy of Periodontology.)

The clinical manifestations of cutaneous leishmaniasis (CL) depend not only on the infecting species involved, but also on the immune response of the individual. Although not yet well understood in humans, parasite survival and persistence are related to the cytokine profile and T cell proliferation, with the Th1 profile being related to cure, and the Th2 profile to disease progression. Considering the need for studies focused on the species with the highest circulation in the state of Amazonas, this study aimed to analyze the immunoregulation stimulated by soluble antigens (SLAs) of Leishmania (L.) amazonensis and Leishmania (V.) guyanensis in human lymphocytes in vitro, in order to understand the immune response of patients with CL. Lymphoproliferation was evaluated against stimuli of SLAs from L. amazonensis (100 µg/mL), SLAs from L. guyanensis (100 µg/mL) and phytohemagglutinin (10 µg/mL) using a BrdU Cell Proliferation ELISA kit after 72 h of incubation. Quantification of the cytokines IL-1b, IL-6, IL-8, IL-10, IL-12 and TNF was performed using the BD™ cytometric bead array human Th1/Th2/Th17 cytokine kit. Our results demonstrated that soluble antigens from L. amazonensis and L. guyanensis stimulated the lymphoproliferation of PBMCs from patients primo-infected with CL. Among the cytokines dosed, the highest concentrations were of IL-6 and IL-8, thus demonstrating that the soluble antigens evaluated are capable of inducing regulatory mechanisms.

Purpose: To answer the following question: 'Do recombinant, purified, and concentrated growth factors enhance the regenerative potential of particulate bone graft substitutes in maxillary sinus floor augmentation (MSA)?', Materials and Methods: Human studies comparing histomorphometric data on new bone formation, residual graft material, and fibrous tissue ratio (outcomes of interest) following MSA procedures employing particulate bone grafts/substitutes in combination or not with growth factors were retrieved from PubMed/MEDLINE, Web of Science, Cochrane, and Scopus online databases and complemented with a hand search. Controlled studies published in English up to December 2022 and reporting on histomorphometric data expressed as volume percentage of the outcomes of interest were considered. Risk of bias was assessed, and a meta-analysis was performed to investigate the effects of supplementary growth factors on new bone formation, remaining graft particles, and fibrous tissue ratio., Results: Data were included from 613 samples in 477 patients reported in 22 publications. Meta-analysis showed that platelet-rich plasma or platelet-rich fibrin resulted in 49% more new bone formation than in control group areas (P &#61; .004), and those areas supplemented with growth factors presented 57% less residual graft particles after healing (P < .0001). A significant (P &#61; .03) 1.85-fold increase in connective tissue formation was noted in areas treated with recombinant human bone morphogenetic proteins (rhBMPs) after healing., Conclusions: Selective supplementary growth factors may enhance new bone formation and accelerate particulate graft turnover, while rhBMP may significantly increase connective tissue formation in MSA procedures in humans.

Buccal bone walls present significant resorption after tooth extraction, possibly related to the smaller bone thickness, length, and the sagittal position of the root, as well as the bone morphology. The goal of the present study was to measure the thickness of the cortical bone of the vestibular and palatal walls in the anterior maxilla by means of CBCT images. Measurements were taken from CBCT scans of 300 maxillary anterior teeth from 50 patients (25 women, 25 men) aged 18 to 30 years. The parameters evaluated included the thickness of the buccal and palatal cortical bone in the cervical, apical, and middle thirds of the root, as well as six specific angular measurements from each tooth. The lateral incisors showed a significant difference in thickness between each of the buccal and palatal thirds, and measurements were also significantly smaller than the central and canine incisors. Bone anatomy is tooth-and location-specific, and thus the sagittal root position within the alveolus influences the regional bone morphology and may explain the gingival zenith position in the anterior maxilla. These specific buccal and palatal anatomic parameters should be carefully taken into consideration for surgical planning and intervention in the esthetic area.

Background: To evaluate the association of thyroid hormones changes, including increased reverse triiodothyronine (rT3) level, with critically ill clinical patients´ mortality., Patients and Methods: This study analyzed the observational data prospectively collected over 8 months (2018) in an adult intensive care unit (ICU) in Brasilia, Brazil. All consecutive ICU-admitted clinical patients were included. Thyroxine (T4), free thyroxine (fT4), triiodothyronine (T3), free triiodothyronine (fT3), rT3, and thyroid-stimulating hormone (TSH) were collected within 48 hours of ICU admission. Patients with hypothyroidism or hyperthyroidism who were previously diagnosed were excluded., Results: Of 353 included patients, age was 68.5 ± 19.0 years, sequential organ failure assessment (SOFA) score was 3.3 ± 2.9, and Acute Physiology and Chronic Health Evaluation II (APACHE II) was 17.1 ± 7.9. ICU mortality was 17.6% ( n = 62). Non-survivor patients had a higher incidence of increased rT3 (69.3 vs 59.2%, p = 0.042), lower incidence of low T4 (4.8 vs 9.7%, p = 0.045), and increased age (75.2 ± 16.3 years vs 67.1 ± 19.3 years, p = 0.001), SOFA (3.0 ± 0.4 vs 2.8 ± 2.6, p <0.001), and APACHE II (23.5 ± 7.5 vs 15.7 ± 7.2, p <0.001). Alterations in other thyroid hormones did not show association with mortality. Increased rT3 [odds ratio (OR): 2.436; 95% confidence interval (CI): 1.023-5.800; p = 0.020] and APACHE II (OR: 1.083, 95% CI: 1.012-1.158; p = 0.044) were associated with ICU mortality in the multivariate analysis., Conclusion: Increased rT3 was independently associated with increased ICU mortality. In contrast, other thyroid hormone alterations did not show an association with mortality. Determining rT3 levels may be a helpful test to identify an increased risk for ICU mortality in clinical patients., How to Cite This Article: da Silveira CDG, de Vasconcelos FPJ, Moura EB, da Silveira BTG, Amorim FFP, Shintaku LS, et al. Thyroid Function, Reverse Triiodothyronine, and Mortality in Critically Ill Clinical Patients. Indian J Crit Care Med 2021;25(10):1161-1166., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.)

Statement of Problem: Unsatisfactory adaptation of restorations with subgingival margins can cause problems such as accumulation of biofilm, secondary caries, and inflammation of the periodontal tissue. Therefore, special attention should be given to gingival displacement and impression procedures to optimize marginal fit., Purpose: The purpose of this systematic review and meta-analysis was to compare gingival displacement with conventional cords and cordless techniques and determine the reliability of the measurement methodologies., Material and Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and identified studies through September 2018. The studies were submitted to the Cochrane risk-of-bias assessment. The gingival displacement was evaluated by using the Review Manager Software., Results: Nine studies were selected, and the most common risks of bias were random sequence generation, blinding of outcome assessment, and absence of sample size calculation. Most of the studies reported obtaining a width greater than 0.2 mm., Conclusions: The cord technique resulted in increased displacement when compared with the cordless technique. The evaluation of sulcular width with digital microscope images obtained from sectioned gypsum casts is an adequate and versatile experimental methodology for measuring displacement., (Copyright © 2019 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Background: The objective of the present study was to compare the efficacy of single-stage laterally positioned flap (LPF) and coronally advanced flap (CAF) techniques in the treatment of localized maxillary gingival recession (GR) defects, 1 and 5 years after surgical procedures., Methods: Thirty-six patients with Miller Class I GR defects were randomly assigned to be treated by either CAF (n = 18) or LPF (n = 18). Recession height (RECH), width of keratinized tissue (WKT), probing depth (PD), vertical clinical attachment level (VAL), visual plaque score (VPS), and bleeding on probing (BOP) were assessed and compared. Clinical recordings were performed at baseline, 1 and 5 years later. The differences between initial clinical recordings and after 1 and 5 years were subjected to statistical analysis., Results: Both flap designs effectively improved RECH and VAL on GR defects. The LPF resulted in significantly more gains in KTW and root coverage (RC) after 5 years., Conclusion: LPF and CAF procedures may be used for the treatment of GR, however, LPF results in greater longitudinal stability of RC and increased WKT in the treated areas., (© 2019 American Academy of Periodontology.)

Background: Alveolar volumetric changes are inherent to the healing process after tooth extraction and filling of the extraction site with biomaterials can reduce these volumetric changes and provide a more favorable environment for the future prosthetic restoration with implants. Among the biomaterials available, biphasic ceramic compounds have shown promissing clinical results, however, histologic evaluation of bone tissue response to different hydration and incorporation methods are limited. The objective of this study was to comparatively evaluate in vivo the osteoconductive potential of the biphasic ceramic bone substitute (SBC) composed of beta-tricalcium phosphate and hydroxyapatite after different hydration methodologies in rat extraction sockets., Methods: Wistar rats (n = 20) were randomly distributed in two subgroups (G1, G2) according to the hydration methods used. After extraction of the right upper central incisor the alveoli were filled with SBC hydrated by two different methods. Group 1: biomaterial hydrated in blood; Group 2: biomaterial hydrated in physiologic saline. The animals were euthanized after 1 and 6 weeks for removal of the bone blocks containing the biomaterial and were submitted to histologic processing. Five-μm-thick demineralized sections of the samples were stained with hematoxylin and eosin (HE) and subjected to histomorphometric analysis., Results: Bone formation was limited 7 days after the extraction procedure and increased in both groups between 7 and 42 days from surgery, demonstrating a time dependent increase of bone volume throughtout the experimental period (p < 0.05)., Conclusions: The hydration of SBC with saline significantly increased new bone formation and reduced connective tissue volume after 42 days demonstrating that hydration method may significantly influence bone healing in such defects, and, thus should be carefully performed., (© 2018 American Academy of Periodontology.)

Objectives: The aim of Working Group 3 was to focus on three topics that were assessed using patient-reported outcome measures (PROMs). These topics included the following: (a) the aesthetics of tooth and implant-supported fixed dental prostheses focusing on partially edentulous patients, (b) a comparison of fixed and removable implant-retained prostheses for edentulous populations, and (c) immediate versus early/conventional loading of immediately placed implants in partially edentate patients. PROMs include ratings of satisfaction and oral health-related quality of life (QHRQoL), as well as other indicators, that is, pain, general health-related quality of life (e.g., SF-36)., Materials and Methods: The Consensus Conference Group 3 participants discussed the findings of the three systematic review manuscripts. Following comprehensive discussions, participants developed consensus statements and recommendations that were then discussed in larger plenary sessions. Following this, any necessary modifications were made and approved., Results: Patients were very satisfied with the aesthetics of implant-supported fixed dental prostheses and the surrounding mucosa. Implant neck design, restorative material, or use of a provisional restoration did not influence patients' ratings. Edentulous patients highly rate both removable and fixed implant-supported prostheses. However, they rate their ability to maintain their oral hygiene significantly higher with the removable prosthesis. Both immediate provisionalization and conventional loading receive positive patient-reported outcomes., Conclusions: Patient-reported outcome measures should be gathered in every clinical study in which the outcomes of oral rehabilitation with dental implants are investigated. PROMs, such as patients' satisfaction and QHRQoL, should supplement other clinical parameters in our clinical definition of success., (© 2018 The Authors. Clinical Oral Implants Research Published by John Wiley & Sons Ltd.)

Aim: The gingival architecture is determined by the spatial orientation of the gingival zenith (GZ) and the inter-dental papillae (IP). Among the factors commonly associated with the presence and morphology of the IP, the contact point (CP) and the inter-dental distance relationships have been considered the most important. The objective of the present controlled clinical trial was to evaluate the role of the CP in determining the clinical and morphometric parameters of the inter-dental papilla., Materials and Methods: The inter-dental papillae of sixty patients with unilateral diastemas were evaluated by means of periodontal probing, transgingival probing, the papilla presence index and morphometric measurement with a digital calliper and were analysed with a paired t-test, with significance set at alpha value of 0.05 or lower., Results: All the papillae exhibited PPI score = 1. Papillary measurements were significantly increased in the experimental (diastema) group., Conclusions: In patients with gingival health, the dimensions of the IP are significantly increased in teeth without a contact point in comparison with their contra-lateral controls with a contact point. The contact point does not determine the presence and size of the inter-dental papilla, in patients with a healthy gingiva and without periodontal attachment loss., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Histologic and histomorphometric evaluations of gingival biopsy samples of patients presenting either a thick or a thin gingival biotype were performed. Full-thickness gingival biopsy samples were obtained and processed for histologic and histometric evaluations. Thickness of the keratinized mucosa or gingiva was found to be increased in the thick biotype. Specifically, the connective tissue layer was thicker with no change in epithelial thickness. In conclusion, gingival transparency appears to be an adequate, clinically useful method to classify the gingival biotype. The thin gingival biotype is manifested by reduced connective tissue thickness; therefore, biotype conversion or enhancement may be based on augmentation of the connective tissue portion of the gingival tissues.

Interaction between epidermal growth factor receptor (EGFR) signaling with GM3 ganglioside expression has been previously described. However, little is known about EGFR and NeuGcGM3 co-expression in cancer patients and their therapeutic implications. In this paper, we evaluate the co-expression of EGFR and NeuGcGM3 ganglioside in tumors from 92 patients and in two spontaneous lung metastasis models of mice (Lewis lung carcinoma (3LL-D122) in C57BL/6 and mammary carcinoma (4T1) in BALB/c). As results, co-expression of EGFR and NeuGcGM3 ganglioside was frequently observed in 63 of 92 patients (68 %), independently of histological subtype. Moreover, EGFR is co-expressed with NeuGcGM3 ganglioside in the metastasis of 3LL-D122 and 4T1 murine models. Such dual expression appears to be therapeutically relevant, since combined therapy with mAbs against these two molecules synergistically increase the survival of mice treated. Overall, our results suggest that NeuGcGM3 and EGFR may coordinately contribute to the tumor cell biology and that therapeutic combinations against these two targets might be a valid strategy to explore., Competing Interests: The authors declare no conflicts of interest. Ethical approval This is a retrospective evaluation and for this type of study, formal consent is not required. All applicable international, national, and/or institutional guidelines for the care and use of animals were followed.

This study compared the clinical outcomes of recombinant human platelet-derived growth factor BB and beta-tricalcium phosphate (rhPDGF-BB/βTCP) with guided bone regeneration (GBR) in immediate implant placement in molar extraction sockets with buccal bone defects versus conventional implant placement. Twenty-eight implants were placed in fourteen patients. Clinical and radiographic evaluations assessed peri-implant soft and hard tissue parameters after 12 months. No implants were lost during the 1-year observation period, yielding a survival rate of 100%. Similar clinical and radiographic parameters were observed for both treatment groups. Use of rhPDGF-BB/βTCP and GBR in immediate implants in molars was as successful as conventional implant placement in fully healed extraction sites.

Aim: The goal of this study was to evaluate if a biological hydrogel of recombinant human Fibroblast Growth Factor type 2 (rhFGF-2) in a hyaluronic acid (HA) carrier applied in periodontal intrabony defects would enhance the clinical parameters of regeneration of the periodontal attachment apparatus, Materials and Methods: Thirty adult patients were evaluated. Two intrabony defects present in contra-lateral quadrants in each patient were randomly allocated for each of the treatment methods employed. Control group (n = 30) were treated by open debridement with the papilla preservation flaps, while the test group (n = 30) also received a topical application of rhFGF-2/HA in the intrabony defect. The parameters evaluated, at baseline and after one year, were, were probing depth (PD), gingival recession (REC), probing attachment level (PAL) and probing bone level (PBL). The primary outcome measures was PAL gain, Results: Test sites exhibited significantly more PD reduction (5.5 versus 2.9 mm), PAL gains (4.8 versus 2.2 mm) and shallower residual PD (4.2 versus 6.6 mm) than controls. Moreover, residual PD smaller than 5 mm (100 versus 0%) and PAL gain > 4 mm (60 versus 20%) was significantly more frequent in the test group, Conclusion: Application of rhFGF-2/HA significantly improved clinical parameters of periodontal wound healing one year after treatment., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: The objective of this study was to evaluate the efficacy of guided bone regeneration (GBR) employing recombinant human platelet-derived growth factor-BB (rhPDGF-BB) incorporated into a beta-tricalcium phosphate (β-TCP)/hydroxyapatite (HA) carrier as a graft material and to compare it to autogenous bone block grafting., Materials and Methods: Adult patients with a site that required bone grafting to increase the thickness of the alveolar bone ridge were treated. After mucoperiosteal flap elevation, experimental bone defects were treated by GBR with rhPDGF incorporated into β-TCP/HA, and control defects were treated with autogenous bone. Primary tension-free wound closure was obtained for all treated sites., Results: Thirty patients were treated. No significant differences were observed between the groups for any of the parameters evaluated, including the amount of bone regeneration and a need for additional grafting., Conclusion: A composite bone ceramic graft that incorporated rhPDGF appears to be a suitable substitute for autogenous bone block grafting when employed in conjunction with GBR in humans.

Purpose: Bone formation and healing are diminished in experimental type 1 diabetes. The present study investigated whether controlled local release of recombinant human bone morphogenetic protein 2 (rhBMP-2) stimulates bone defect healing in diabetes as a consequence of its anabolic effects on bone., Materials and Methods: Bilateral experimental circular bone defects were created in the temporal bones of 64 BALB/cByJ mice. Defects were treated with acellular collagen sponge plus 0.4 or 1.8 μg of rhBMP-2 per defect, and untreated defects served as controls. The healing of the defects over a 14-day period in diabetic and nondiabetic mice was analyzed histomorphometrically., Results: Diabetes inhibited bone formation in both untreated and BMP-treated bone defects. Controlled local release of rhBMP-2 significantly stimulated bone formation in diabetic animals, bringing it nearly to normal levels, and enhanced bone regeneration in normal animals., Conclusion: Recombinant human BMP-2 may be beneficial in treating deficient intramembranous bone formation in diabetes.

Background: Treatment of molar furcation defects remains a considerable challenge in clinical practice. The degree of success in the management of furcation involvement is highly variable and related to the baseline clinical status of these defects. The identification of clinical parameters influential to the treatment outcomes is critical to optimize the results of surgical periodontal therapy. The impact of the endodontic treatment (ET) of the tooth on the healing potential of the periodontium is controversial. Therefore, the objective of this study is to evaluate the clinical response of buccal Class II furcation defects to open-flap debridement (OFD) and to determine the influence of ET in the clinical outcomes of therapy., Methods: Sixty patients were divided into two treatment groups (n = 30): 1) OFD; and 2) OFD in endodontically treated teeth (OFD + ET). The clinical variables evaluated were plaque (full-mouth plaque score), bleeding on probing, gingival recession, probing depth (PD), and vertical (VAL) and horizontal (HAL) attachment levels. Reevaluation was performed 12 months after the surgical procedures., Results: Both treatments resulted in improvements in all the clinical variables evaluated. Postoperative measurements from OFD-treated and OFD + ET-treated sites showed, respectively, 1.2 ± 1.2 and 1.3 ± 1.3 mm reduction in PD, 0.6 ± 0.8 and 0.7 ± 0.6 mm VAL gains, and 0.7 ± 1.1 and 0.8 ± 1.6 mm HAL gains. No significant differences were found between the groups., Conclusion: The present findings demonstrate that adequate endodontic therapy performed ≥6 months before surgical treatment does not significantly influence the clinical parameters of healing of human mandibular buccal Class II furcation defects.

Background: The semilunar incision was introduced in oral surgery more than a century ago. The semilunar coronally re-positioned flap (SLCRF) is one of the variants of this procedure; however, no previous controlled clinical study has evaluated the SLCRF performed as originally described. The objective of the present study was to compare the clinical outcomes of the SLCRF and coronally advanced flap (CAF) procedure in the treatment of maxillary Miller class I recession (GR) defects., Materials and Methods: Twenty-two patients, with 22 contra-lateral Miller class I GR defects, were randomly assigned to CAF or SLCRF. Clinical parameters assessed included recession height, width of keratinized tissue, probing depth, vertical clinical attachment level, visual plaque score and bleeding on probing. Clinical recordings were performed at baseline and 6 months later. Inter-measurements differences were analysed with a chi(2) or a paired t-test, with significance set at alpha<0.05., Results: Both flap designs were effective in obtaining and maintaining a coronal displacement of the gingival margin. The CAF resulted in clinical improvements significantly better than SLCRF for percentage of root coverage (RC), frequency of complete RC and gain in clinical attachment level. RC obtained in the immediate post-surgical period of SLCRF-treated sites was not maintained throughout the subsequent evaluations., Conclusion: RC is significantly better with CAF compared with the original SLCRF technique in the treatment of shallow maxillary Miller class I GR defects.

Background: Surface topography and porosity of barrier membranes is suggested to impact the soft and hard tissue response. In this study, the specific soft and hard tissue response characteristics of a synthetic polylactide membrane are evaluated including soft tissue inflammation, osteogenesis, and osteopromotion., Methods: Analysis of porosity and surface topography of the test material was performed by scanning electron microscopy. Transosseous parietal defects were surgically created bilaterally in 32 BalbC/ByJ mice and treated either with the barrier (test) or sham-operated (control). Healing was assessed histologically and histomorphometrically with quantification of bone bridging., Results: Scanning electron microscopy analyses of the barrier revealed a microstructure resembling cancellous bone. Interconnecting pores and channels, measuring between 6 and 60 microm in diameter, formed by smooth internal walls were observed throughout the device. Two distinct patterns of porosity were observed. The external surface of the membrane was characterized by a highly porous structure, with minimal interporous nodes and average pore sizes ranging between 6 and 20 microm in diameter. The internal surface was characterized by a minimal porous structure, with significant interporous nodes and average pore sizes ranging between 18 and 60 mum in diameter. Histomorphometric analyses demonstrated increased bone bridging by 60% and 300% in membrane-treated sites after 14 and 28 days of healing, respectively. The rough surface of the barrier contained significantly more giant cells, whereas the smooth surface contained significantly more inflammatory cells., Conclusion: The surface topographies engineered on different sides of the barrier promote differential soft tissue responses leading, however, to similar amounts of enhanced bone formation.

Background: Several procedures have been reported for the surgical correction of gingival recession (GR), including the laterally positioned flap (LPF) and the coronally advanced flap (CAF), performed as single- or two-stage procedures without or with, respectively, the preceding placement and healing of a free gingival graft. The objective of the present report was to compare the efficacy of single-stage LPF and CAF techniques in the treatment of localized maxillary GR defects., Methods: Thirty-six patients, 10 men and 26 women, with average age of 34 + or - 9 years with Miller Class I GR defects were randomly assigned to be treated by either a CAF (n = 18) or LPF (n = 18). Clinical parameters, including recession height, the width of keratinized tissue (WKT), probing depth, and vertical clinical attachment level were assessed at the mid-buccal site. Visual plaque score and bleeding on probing were also assessed dichotomously. Clinical recordings were performed at baseline and 6 months later. Intermeasurements differences were analyzed with a chi-square or a Wilcoxon test, with significance set at alpha<0.05., Results: Both flap designs were effective in treating recession defects resulting in similar improvements for percentage of root coverage, frequency of complete root coverage, and gain in clinical attachment level. The LPF resulted in significantly more gains in WKT than the CAF., Conclusion: The results obtained by CAF in the treatment of Miller Class I maxillary GR are clinically similar to the LPF albeit with more limited gains in WKT.

Background: The presence of the periodontal ligament (PDL) makes it possible to absorb and distribute loads produced during masticatory function and other tooth contacts into the alveolar process via the alveolar bone proper. However, several factors affect the integrity of periodontal structures causing the destruction of the connective matrix and cells, the loss of fibrous attachment, and the resorption of alveolar bone., Methods: The purpose of this study was to evaluate the stress distribution by finite element analysis in a PDL in three-dimensional models of the upper central incisor under three different load conditions: 100 N occlusal loading at 45 degrees (model 1: masticatory load); 500 N at the incisal edge at 45 degrees (model 2: parafunctional habit); and 800 N at the buccal surface at 90 degrees (model 3: trauma case). The models were built from computed tomography scans., Results: The stress distribution was quite different among the models. The most significant values (harmful) of tensile and compressive stresses were observed in models 2 and 3, with similarly distinct patterns of stress distributions along the PDL. Tensile stresses were observed along the internal and external aspects of the PDL, mostly at the cervical and middle thirds., Conclusions: The stress generation in these models may affect the integrity of periodontal structures. A better understanding of the biomechanical behavior of the PDL under physiologic and traumatic loading conditions might enhance the understanding of the biologic reaction of the PDL in health and disease.

Background: The treatment of molar furcation defects remains a considerable challenge in clinical practice. The degree of success in the management of furcation involvement is highly variable and inversely related to initial probing depth (PD) measurements in these lesions. The identification of clinical measurements influential to the treatment outcomes is critical to optimize the results of surgical periodontal therapy. Therefore, the objective of this study was to evaluate the clinical response of mandibular buccal Class II furcation lesions to a combined regenerative treatment modality., Methods: Sixty patients were divided into two (n = 30) treatment groups. An experimental combined regenerative therapy (ET) was compared to open flap debridement (OFD). The ET was a combination of a composite graft consisting of bioabsorbable hydroxyapatite and tetracycline (3:1), a guided tissue regeneration barrier, and a coronally advanced flap. The clinical variables evaluated were plaque, bleeding on probing, gingival recession, PD, vertical attachment level (VAL), horizontal attachment level (HAL), furcation vertical height, furcation horizontal depth, and the amount of tissue under the barrier membrane at uncovering. Reevaluation was performed 12 months after the surgical procedure., Results: Both treatments resulted in improvements in all clinical variables evaluated. Postoperative measurements revealed a reduction in PD of 3.65 +/- 0.6 mm and 0.60 +/- 1.0 mm; VAL gains of 3.05 +/- 0.6 mm and 0.65 +/- 0.6 mm and HAL gains of 3.45 +/- 1.3 mm and 0.55 +/- 0.7 mm in the ET and OFD groups, respectively. In the ET group, significant positive correlations were found between baseline PD and PD reduction at 12 months, and the initial VAL correlated positively with PD reduction and HAL gain. The horizontal furcation depth and amount of tissue formed under the membrane at uncovering correlated positively with PD reduction and HAL and VAL gains. For the OFD group, the initial PD correlated positively with PD reduction and VAL and HAL gains and correlated negatively with recession. Initial VAL correlated positively with PD reductions and VAL and HAL gains. The initial HAL correlated negatively with recession at 12 months., Conclusions: ET exhibited significantly better clinical results, with more PD reduction, HAL and VAL gains, and a higher frequency of furcation closure compared to OFD and showed promise as a regenerative treatment technique. The ability to predict a response to treatment based upon pretreatment parameters was not consistent between groups; thus, prediction of treatment outcomes based on pretreatment measurements should be carefully evaluated for each treatment modality.

Background: The appearance of gingival tissues plays an important role in the esthetics of the anterior maxillary region of the mouth. The gingival zenith (GZ) is defined as the most apical point of the marginal gingival scallop; however, its quantitative orientation in the apico-coronal (AC) and mesio-distal (MD) directions has not been reported. Thus, this study aimed to quantify the specific spatial displacement of the GZ in the maxillary anterior dentition., Methods: Bilateral measurements, taken with a digital caliper in maxillary stone casts from periodontally healthy volunteers, were recorded to the nearest 1/100th millimeter in the canine (C), lateral incisor (LI), and central incisor (CI) teeth to evaluate the MD displacement of the GZ in relation to the long axis of the crowns and the AC displacement of the GZ of LI teeth in relation to CI and C teeth. Intermeasurement differences were analyzed with the chi(2) or paired t test, with significance set at alpha <0.05., Results: The GZ was distally displaced between 0.06 and 0.96 mm in 12%, 70%, and 96% of the C, LI, and CI teeth, respectively. The majority of the population (70%) presented with the GZ of LI teeth positioned 0.75 +/- 0.60 mm coronally to the GZ of the ipsilateral C and CI., Conclusions: The GZ is not universally displaced toward the distal aspect. The frequency and magnitude of distal displacement is tooth-dependent and larger in CI than in LI, which, in turn, is larger than in C. Consideration of these findings may improve clinical management of the dentogingival complex and enhance periodontal and restorative procedures in the anterior maxillary dentition.

Purpose: Bone formation and the healing of calvarial defects in mice is diminished in chemically induced type 1 diabetes. The present study investigated whether controlled local release of fibroblast growth factor 2 (FGF-2) stimulates bone defect healing in this model of diabetes., Materials and Methods: First, in vitro release kinetics of different doses of recombinant human FGF-2 (rhFGF-2) from polyglycolate:polylactide membranes was determined over a 14-day period by incubating loaded membranes in PBS with constant shaking. The amount of FGF-2 was measured by enzyme-linked immunosorbent assay. Then, the effects of rhFGF-2-loaded and control membranes on calvarial defect healing over a 14-day healing period were determined in diabetic and nondiabetic mice. The degree of healing was determined by histomorphometric analyses of bone area percentage and by area measurements. The significance of the data was determined by statistical analyses, including analysis of variance., Results: Kinetic release data in vitro showed that membranes loaded with 5 microg FGF-2 released measurable levels of growth factor for more than 14 days. Data from the in vivo study supported the previous finding that diabetes inhibits bone formation. Membranes containing rhFGF-2 significantly (P < .05) stimulated bone formation in diabetic animals to near normal levels during the healing period., Conclusion: FGF-2-loaded membranes may be useful in further studies aimed at developing therapeutic strategies for correcting deficient bone healing in patients with diabetes.

The aim of this study was to investigate postsurgical periodontal probe penetration by using clinical information and histometric data. Thirty-eight three-walled defects were created in four dogs, then maintained for 3 months. Subsequently, 26 defects were subjected to periodontal surgery (surgical group), while 12 defects served as controls. The dogs were sacrificed at 4, 8, 12, and 16 weeks. Immediately before sacrifice, endodontic silver points were placed in the gingival crevices as substitutes for periodontal probes and fixed on the teeth. Following block sections, histologic and histomorphometric evaluations were undertaken: location of the probe tip in relation to the apical termination of the junctional epithelium, length of new junctional epithelium in relation to the apical junctional epithelium, and mean length of connective tissue adhesion in relation to the apical junctional epithelium. Probe tips were located -1.37 +/- 1.73 mm and -0.20 +/- 0.15 mm apical to the apical junctional epithelium for the surgical and control groups, respectively, at 4 weeks, while the probe tip was located 0.58 +/- 0.31 mm and 0.40 +/- 0.20 mm coronal to the apical junctional epithelium, respectively, at 16 weeks. Length of new junctional epithelium in relation to apical junctional epithelium was significantly less for the surgical than the control group at 4 weeks (0.73 +/- 0.60 mm vs 1.19 +/- 0.02 mm) and 8 weeks (1.77 +/- 0.52 mm vs 2.15 +/- 0.00 mm). There were no significant differences between the groups in regard to connective tissue relationship to the apical junctional epithelium. Periodontal probing is not recommended for at least 2 months after surgical procedures; before this stage, probing forces may damage the soft tissue-tooth interrelationship.

Differentiation of phenotypically normal osteoblast cultures leads to formation of a bone-like extracellular matrix in vitro. Maximum collagen synthesis occurs early in the life of these cultures, whereas insoluble collagen deposition occurs later and is accompanied by a diminished rate of collagen synthesis. The mechanisms that control collagen deposition seem likely to include regulation of extracellular collagen biosynthetic enzymes, but expression patterns of these enzymes in differentiating osteoblasts has received little attention. The present study determined the regulation of lysyl oxidase as a function of differentiation of phenotypically normal murine MC3T3-E1 cells at the level of RNA and protein expression and enzyme activity. In addition, the regulation of BMP-1/mTLD mRNA levels that encodes procollagen C-proteinases was assayed. The role of lysyl oxidase in controlling insoluble collagen accumulation was further investigated in inhibition studies utilizing beta-aminopropionitrile, a specific inhibitor of lysyl oxidase enzyme activity. Results indicate that lysyl oxidase is regulated as a function of differentiation of MC3T3-E1 cells, and that the maximum increase in lysyl oxidase activity precedes the most efficient phase of insoluble collagen accumulation. By contrast BMP-1/mTLD is more constitutively expressed. Inhibition of lysyl oxidase in these cultures increases the accumulation of abnormal collagen fibrils, as determined by solubility studies and by electron microscopy. Taken together, these data support that regulation of lysyl oxidase activity plays a key role in the control of collagen deposition by osteoblast cultures., (Copyright 2004 Wiley-Liss, Inc.)

Background: Successful treatment of molar furcation defects remains a challenge in clinical practice. Knowledge of anatomic factors facilitates predictable management of furcation involvement lesions. The degree of success in managing furcation involvement is inversely related to the horizontal probing depth. The depth of the horizontal component of attachment loss can vary depending on the external tooth-surface reference points used. However, the anatomical factors affecting horizontal component of attachment loss have not been previously assessed. Therefore, this study determined the bucco-lingual measurements of the cemento-enamel junction and the mesial and distal roots and at the level of root separation., Methods: One hundred extracted permanent human mandibular first (N = 50) and second (N = 50) molars were studied. Four horizontal bucco-lingual widths were measured with calibrated calipers: 1) furcation entrance/roof (FE); 2) cemento-enamel junction level (CEJ); 3) mesial root width (MRW); and 4) distal root width (DRW)., Results: The mean widths at FE, CEJ, MRW, and DRW were, respectively, 5.53 +/- 0.45 mm, 8.71 +/- 0.54 mm, 8.57 +/- 0.54 mm, and 7.97 +/- 0.65 mm in the first molars and 5.61 +/- 0.65 mm, 8.40 +/- 0.65 mm, 7.95 +/- 0.88 mm, and 7.16 +/- 0.84 mm in the second molars. Analysis of variance revealed significant differences between FE and the other variables tested. The results showed that the bucco-lingual width of the furcation roof is considerably shorter than the MRW and DRW. The difference in the mean bucco-lingual dimension between FE and the other measurements occurred in all teeth evaluated and varied between 0.7 and 4.30 mm., Conclusions: Our findings demonstrate that clinical measurements of horizontal probing depth that use the external surfaces of roots as reference points overestimate the true anatomical component of furcation involvement in mandibular molars. Conversely, positive treatment outcomes in these teeth may be underestimated. This has implications not only for clinical practice but also for clinical research studies evaluating treatment outcomes.

The effect of type 1 diabetes on bone healing and bone formation in standardized craniotomy defects created in BALB/cByJ mice was determined. The hypothesis that advanced glycation end products (AGEs) contribute to diminished bone healing in diabetes was evaluated by assessing for the presence of the receptor for advanced glycation end products (RAGE) by immunohistochemistry in healing craniotomy defects in diabetic animals. The effect of local application of a known RAGE protein ligand, N(epsilon)-(carboxymethyl)lysine (CML)-mouse serum albumin (MSA), on craniotomy defect healing in normal animals was then assessed and compared to the effects of control MSA. Finally, evidence in support of the expression of RAGE mRNA and protein in osteoblastic cells was obtained. The results indicated that craniotomy defects in diabetic animals healed approximately 40% of the degree to which they healed in nondiabetic animals (P < 0.05). RAGE was expressed at higher levels in healing bone tissues in diabetic compared to control animals. Further studies in nondiabetic animals indicated that bone healing was reduced by 63 and 42% in lesions treated with 900 and 90 micro g CML-MSA, respectively, compared to in animals treated with MSA alone (P < 0.05). Evidence for the expression of RAGE was obtained in mouse and rat osteoblastic cultures. These results support the contribution of AGEs to diminished bone healing in type 1 diabetes, possibly mediated by RAGE.

The role of matrix metalloproteinases (MMPs) in the breakdown of pulp tissue of teeth with severe caries has not yet been directly elucidated. This study was to determine the levels of selected MMPs and the overall gelatinolytic activity in clinically healthy and inflamed human dental pulps of 29 healthy subjects, aged 10-19 yr. Seventeen pulps were collected from subjects diagnosed with symptomatic pulpitis, and 18 control pulps were obtained from 12 subjects following premolar extraction for orthodontic reasons. The levels of MMP-1, MMP-2, MMP-3 and MMP-9 were determined with enzyme-linked immunosorbent assay. Densitometric analysis of gelatin zymograms was used to assay gelatinolytic activity in pulp supernatants. The MMP-1 levels were below the detection limit for both groups. Levels of MMP-2 and MMP-3 were significantly lower in symptomatic vs. clinically healthy pulps. In contrast, levels of MMP-9 in inflamed pulps were significantly higher than those recorded in clinically normal pulps. The overall gelatinolytic activity was elevated in inflamed pulps compared with healthy counterparts. Further, the gelatinolytic activity was positively correlated with MMP-9 levels. The data obtained suggest a key role of MMP-9 in the breakdown of inflamed human dental pulp tissue.

Treatment of maxillary furcation lesions presents important clinical challenges. The aim of this study was to evaluate the response of buccal class II furcation defects in systemically healthy, non-smoking, Adult Periodontitis patients undergoing supportive periodontal therapy and surgical periodontal regenerative techniques. The treatment protocol emphasised infection control, careful soft tissue management and wound stability. Two experiments were performed. In the first experiment, a coronally positioned flap (CPF) technique was compared with surgical debridement. In the second experiment, an experimental technique (ET) was also compared with surgical debridement. The ET was a combination of a composite graft consisting of microparticulate (40-70 microns) hydroxyapatite and tetracycline (3:1), a guided tissue regeneration barrier (GTR) and CPF. Sixty patients were divided into the four (n = 15) treatment groups. The clinical variables evaluated were plaque, bleeding-on-probing scores, gingival recession, probing pocket depth (PD), vertical (VAL) and horizontal attachment levels (HAL). Reevaluation was performed 12 months after the surgical procedures and revealed that the three techniques resulted in improvements in all the clinical variables evaluated. Post-operative measurements from controls, CPF and ET showed (respectively) 1.53 +/- 1.12 mm, 1.40 +/- 0.75 mm, 2.43 +/- 1.36 mm reduction in PD; 0.63 +/- 0.1 mm, 1.17 +/- 1.12 mm and 1.57 +/- 1.32 mm VAL gains and 1.03 +/- 0.30 mm, 1.40 +/- 0.96 mm and 2.13 +/- 1.52 mm HAL gains. Five out of fifteen furcations in the ET group were closed after treatment. It was concluded that satisfactory clinical results--measured by PD reduction, VAL and HAL gains--can be obtained in advanced defects formerly considered as being non-responsive to regenerative periodontal therapy. The proposed ET showed significantly better results, with more PD reduction, HAL and VAL gains and a higher frequency of furcation closure compared with the other techniques tested, and shows promise as a new regenerative treatment technique.