Alterações longitudinais no perfil microbiológico e parâmetros clínicos periodontais de incisivos centrais superiores com periodonto reduzido submetidos à intrusão dentária
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Data
2020-03-25
Autores
Gutierrez, Lorena Silva
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Universidade Estadual Paulista (Unesp)
Resumo
A movimentação dentária ortodôntica em pacientes adultos com histórico de doença periodontal requer um planejamento complexo, devido à reabsorção óssea, e a dificuldade de se obter uma ancoragem satisfatória por consequência da perda de elementos dentários. O objetivo deste trabalho foi avaliar as alterações longitudinais no perfil microbiológico e nos parâmetros clínicos periodontais de incisivos centrais superiores com periodonto reduzido durante e após término do movimento de intrusão dentária. Vinte pacientes com doença periodontal foram selecionados de acordo com os critérios do estudo. Estes pacientes deveriam apresentar incisivos centrais superiores vestibularizados e extruídos com perda de inserção ≥ 5 mm e indicação de intrusão dentária. Todos os sítios com atividade de doença periodontal receberam raspagem e alisamento radicular (RAR) e para o tratamento ortodôntico ser iniciado, os incisivos centrais superiores deveriam apresentar estabilidade no nível clínico de inserção após 90 dias do término do tratamento periodontal ativo. Os parâmetros clínicos Índice de placa (IP), Índice Gengival (IG), profundidade de sondagem (PS), nível clínico de inserção (NCI), recessão gengival (RG), sangramento à sondagem (SS) e tamanho de coroa clínica (TCC) foram avaliados antes do procedimento de RAR, no início do movimento de intrusão (T1- Baseline), durante o movimento de intrusão (90 e 180 dias), imediatamente após o término da intrusão ortodôntica (T2), 90 e 180 dias após o término do tratamento de intrusão. Coletas de amostras de fluido crevicular gengival (FCG) foram realizadas imediatamente antes do início da intrusão, após 90 dias do início da intrusão, imediatamente após término da intrusão e após 180 dias do término da intrusão para detecção de periodontopatógenos Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Treponema denticola (Td) e Tannerella forsythia (Tf), pela técnica de RT-PCR. Os resultados mostraram uma melhora significante em todos os parâmetros clínicos periodontais avaliados comparados aos valores de antes da intrusão (T1-Baseline), inclusive ganho de inserção. O IP reduziu de 38,8% para 13,1%; IG diminuiu de 39,6% para 14,9%; SS reduziu de 28,7% para 8,2%; A PS reduziu de 6,0±0,2 para 2,6±0,2; o NCI reduziu de 7,8±0,3 para 4,8±0,4; a RG reduziu de 2,8±0,2 para 0,6±0,2 e o TCC reduziu de 12,0±0,4 para 9,6±0,2. Na análise microbiológica, não foram encontradas diferenças estatisticamente significativas na quantidade dos periodontopatógenos no biofilme subgengival entre os diferentes períodos de avaliação do estudo. Conclui-se que a intrusão ortodôntica pode influenciar positivamente na melhora dos parâmetros clínicos periodontais após tratamento de RAR, porém, sem mudanças significantes na quantidade de periodontopatógenos presentes.
Orthodontic tooth movement in adult patients with a history of periodontal disease requires complex planning, due to bone resorption, and the difficulty of achieving satisfactory anchorage as a result of loss of dental elements. The objective of this study was to evaluate longitudinal changes in microbiology and clinical periodontal parameters of upper central incisors, in patients with reduced periodontium, before, during and after orthodontic intrusion. Twenty patients with periodontal disease were selected according to the study criteria. These patients should have vestibularized and extruded upper central incisors with insertion loss ≥ 5 mm and indication of dental intrusion. All sites with activity of periodontal disease received scaling and root planing (RAR) and for orthodontic treatment to be started, the upper central incisors should have stability in the clinical level of insertion after 90 days of the end of active periodontal treatment. Clinical parameters Plaque index (PI), Gingival index (GI), probing depth (PD), clinical level of insertion (CLI), gingival recession (GR), probing bleeding (PB) and clinical crown size (CCS) were evaluated before the RAR procedure, at the beginning of the intrusion movement (T1- Baseline), during the intrusion movement (90 and 180 days), immediately after the end of the orthodontic intrusion (T2), 90 and 180 days after the end of the intrusion treatment. Sample collections of gingival crevicular fluid (GFC) were performed during the intrusion movement (immediately and after 90 days from the beginning), immediately and after 180 days from the end of the intrusion treatment, to detect periodontopathogens Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Treponema denticola (Td) and Tannerella forsythia (Tf) by the technique of RT-PCR. The results showed a significant improvement in all evaluated periodontal clinical parameters compared to the values before the intrusion (T1-Baseline), including insertion gain. The PI decreased from 38.8% to 13.1%; MBI decreased from 39.6% to 14.9%; PB decreased from 28.7% to 8.2%; The PD decreased from 6.0 ± 0.2 to 2.6 ± 0.2; the CIL decreased from 7.8 ± 0.3 to 4.8 ± 0.4; the GR decreased from 2.8 ± 0.2 to 0.6 ± 0.2 and the CCS decreased from 12.0 ± 0.4 to 9.6 ± 0.2. In the microbiological analysis, no statistically significant differences were found in the amount of periodontopathogens in the subgingival biofilm between the different periods of evaluation of the study. It is concluded that orthodontic intrusion can positively influence the improvement of periodontal clinical parameters after RAR treatment, however, without significant changes in the amount of periodontopathogens present.
Orthodontic tooth movement in adult patients with a history of periodontal disease requires complex planning, due to bone resorption, and the difficulty of achieving satisfactory anchorage as a result of loss of dental elements. The objective of this study was to evaluate longitudinal changes in microbiology and clinical periodontal parameters of upper central incisors, in patients with reduced periodontium, before, during and after orthodontic intrusion. Twenty patients with periodontal disease were selected according to the study criteria. These patients should have vestibularized and extruded upper central incisors with insertion loss ≥ 5 mm and indication of dental intrusion. All sites with activity of periodontal disease received scaling and root planing (RAR) and for orthodontic treatment to be started, the upper central incisors should have stability in the clinical level of insertion after 90 days of the end of active periodontal treatment. Clinical parameters Plaque index (PI), Gingival index (GI), probing depth (PD), clinical level of insertion (CLI), gingival recession (GR), probing bleeding (PB) and clinical crown size (CCS) were evaluated before the RAR procedure, at the beginning of the intrusion movement (T1- Baseline), during the intrusion movement (90 and 180 days), immediately after the end of the orthodontic intrusion (T2), 90 and 180 days after the end of the intrusion treatment. Sample collections of gingival crevicular fluid (GFC) were performed during the intrusion movement (immediately and after 90 days from the beginning), immediately and after 180 days from the end of the intrusion treatment, to detect periodontopathogens Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Treponema denticola (Td) and Tannerella forsythia (Tf) by the technique of RT-PCR. The results showed a significant improvement in all evaluated periodontal clinical parameters compared to the values before the intrusion (T1-Baseline), including insertion gain. The PI decreased from 38.8% to 13.1%; MBI decreased from 39.6% to 14.9%; PB decreased from 28.7% to 8.2%; The PD decreased from 6.0 ± 0.2 to 2.6 ± 0.2; the CIL decreased from 7.8 ± 0.3 to 4.8 ± 0.4; the GR decreased from 2.8 ± 0.2 to 0.6 ± 0.2 and the CCS decreased from 12.0 ± 0.4 to 9.6 ± 0.2. In the microbiological analysis, no statistically significant differences were found in the amount of periodontopathogens in the subgingival biofilm between the different periods of evaluation of the study. It is concluded that orthodontic intrusion can positively influence the improvement of periodontal clinical parameters after RAR treatment, however, without significant changes in the amount of periodontopathogens present.
Descrição
Palavras-chave
Doenças Periodontais, Perda da Inserção Periodontal, Técnicas de Movimentação Dentária, Periodontal Diseases, Periodontal Attachment Loss, Tooth Movement Techniques