Tratamiento multidisciplinario en una paciente con periodontitis agresiva generalizada y diabetes mellitus tipo 1

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Abstract

El impacto de las enfermedades sistémicas sobre la salud bucal se encuentra bien documentado. Algunos desórdenes sistémicos pueden modificar la respuesta inmune del huésped a los patógenos periodontales, exacerbando la severidad de la enfermedad periodontal. Dentro de las enfermedades sistémicas, la diabetes mellitus no controlada se encuentra asociada con la severidad de la enfermedad periodontal. La periodontitis agresiva se presenta en adultos jóvenes, causando una rápida destrucción del aparato de inserción periodontal. La pérdida severa del soporte periodontal presente en estos casos dificulta el pronóstico de los dientes y, por lo tanto, para el clínico se complica la planificación del tratamiento, y existe la posibilidad de extraer los dientes comprometidos. Para realizar un tratamiento integral es necesaria la participación de otras áreas odontológicas. El objetivo de este trabajo es presentar el tratamiento multidisciplinario en una paciente femenina de 17 años de edad con diabetes mellitus tipo 1 y periodontitis agresiva generalizada, y los resultados de su tratamiento a un año.

Translated abstract

The impact of systemic diseases on oral health has been well documented. Certain systemic disorders can modify the host's immune response to periodontal pathogens, thus exacerbating the severity of the periodontal disease. Among systemic diseases, uncontrolled diabetes mellitus is associated to periodontal disease. Aggressive periodontitis can appear in young adults and elicit rapid destruction of the periodontal insertion apparatus. Severe loss of periodontal support present in these cases hinders prognosis of affected teeth, and thus, the clinician faces complications when designing treatment plans and deciding upon extraction or non extraction of compromised teeth. Accomplishment of comprehensive treatment requires participation of other fields of dentistry. The aim of the present study was to present the multi-disciplinary treatment of a 17-year-old female patient afflicted with type 1 diabetes mellitus and generalized aggressive periodontitis, and present results obtained one year after completion of treatment.

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The efficacy of bone replacement grafts in the treatment of periodontal osseous defects. A systematic review.

Mark A. Reynolds, Mary Elizabeth Aichelmann-Reidy, Grishondra Branch-Mays … (2003)

Bone replacement grafts (BRG) are widely used in the treatment of periodontal osseous defects; however, the clinical benefits of this therapeutic practice require further clarification through a systematic review of randomized controlled studies. The purpose of this systematic review is to access the efficacy of bone replacement grafts in proving demonstrable clinical improvements in periodontal osseous defects compared to surgical debridement alone. What is the effect of bone replacement grafts compared to other interventions on clinical, radiographic, adverse, and patient-centered outcomes in patients with periodontal osseous defects? The computerized bibliographical databases MEDLINE and EMBASE were searched from 1966 and 1974, respectively, to October 2002 for randomized controlled studies in which bone replacement grafts were compared to other surgical interventions in the treatment of periodontal osseous defects. The search strategy included screening of review articles and reference lists of retrieved articles as well as hand searches of selected journals. All searches were limited to human studies in English language publications. Non-randomized observational studies (e.g., case reports, case series), publications providing summary statistics without variance estimates or data to permit computation, and studies without BRG intervention alone were excluded. The therapeutic endpoints examined included changes in bone level, clinical attachment level, probing depth, gingival recession, and crestal resorption. For purposes of meta-analysis, change in bone level (bone fill) was used as the primary outcome measure, measured upon surgical re-entry or transgingival probing (sounding). 1. Forty-nine controlled studies met eligibility criteria and provided clinical outcome data on intrabony defects following grafting procedures. 2. Seventeen studies provided clinical outcome data on BRG materials for the treatment of furcation defects. 1. With respect to the treatment of intrabony defects, the results of meta-analysis supported the following conclusions: 1) bone grafts increase bone level, reduce crestal bone loss, increase clinical attachment level, and reduce probing depth compared to open flap debridement (OFD) procedures; 2) No differences in clinical outcome measures emerge between particulate bone allograft and calcium phosphate (hydroxyapatite) ceramic grafts; and 3) bone grafts in combination with barrier membranes increase clinical attachment level and reduce probing depth compared to graft alone. 2. With respect to the treatment of furcation defects, 15 controlled studies provided data on clinical outcomes. Insufficient studies of comparable design were available to submit data to meta-analysis. Nonetheless, outcome data from these studies generally indicated positive clinical benefits with the use of grafts in the treatment of Class II furcations. 3. With respect to histological outcome parameters, 2 randomized controlled studies provide evidence that demineralized freeze-dried bone allograft (DFDBA) supports the formation of a new attachment apparatus in intrabony defects, whereas OFD results in periodontal repair characterized primarily by the formation of a long junctional epithelial attachment. Multiple observational studies provide consistent histological evidence that autogenous and demineralized allogeneic bone grafts support the formation of new attachment. Limited data also suggest that xenogenic bone grafts can support the formation of a new attachment apparatus. In contrast, essentially all available data indicate that alloplastic grafts support periodontal repair rather than regeneration. 4. The results of this systematic review indicate that bone replacement grafts provide demonstrable clinical improvements in periodontal osseous defects compared to surgical debridement alone.

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Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis: a randomized placebo-controlled clinical trial.

Matthew D Moles, Dean S. Griffiths, Luigi Nibali … (2005)

The objective of this study was to assess the adjunctive clinical effect of the administration of systemic amoxicillin and metronidazole in the non-surgical treatment of generalized aggressive periodontitis (GAP). Forty-one systemically healthy subjects with GAP were included in this 6-month double-blind, placebo-controlled, randomized clinical trial. Patients received a course of full-mouth non-surgical periodontal treatment delivered over a 24 h period using machine-driven and hand instruments. Test subjects received an adjunctive course of systemic antibiotic consisting of 500 mg amoxicillin and 500 mg metronidazole three times a day for 7 days. Clinical parameters were collected at baseline, and at 2 and 6 months post-treatment. In both the test and the placebo groups, all clinical parameters improved at 2 and 6 months. In deep pockets (> or =7 mm), the test treatment resulted in an additional 1.4 mm (95% confidence interval 0.8, 2.0 mm) in full-mouth probing pocket depth (PPD) reduction and 1 mm (0.7, 1.3 mm) of life cumulative attachment loss (LCAL) gain at 6 months. In moderate pockets (4-6 mm), the adjunctive benefit was smaller in magnitude: PPD reduction was 0.4 mm (0.1, 0.7 mm) and LCAL gain was 0.5 mm (0.2, 0.8 mm). In addition, the 6-month data showed LCAL gains > or =2 mm at 25% of sites in test patients compared with 16% in placebo (p=0.028). Similarly, PPD reductions of 2 mm or more were observed in 30% of sites in test and 21% of sites in placebo patients. Seventy-four percent of pockets with PPD > or =5 mm at baseline were 4 mm or shallower at 6 months in the test group. This compared with 54% in the placebo group (p=0.008). Disease progression at 6 months was observed at 1.5% of test and 3.3% of sites in test and placebo, respectively (p=0.072). These data indicate that a 7-day adjunctive course of systemic metronidazole and amoxicillin significantly improved the short-term clinical outcomes of full-mouth non-surgical periodontal debridement in subjects with GAP.

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Diabetes and periodontal disease: a case-control study.

Giancarlo Tonolo, Edoardo BALDONI, Guglielmo Campus … (2005)

Periodontitis is often associated with diabetes and might be considered one of the chronic complications of diabetes mellitus, both in Type 1 (T1DM) and Type 2 (T2DM). This case-control study was designed to evaluate the possible association between non-insulin-dependent diabetes (T2DM) and clinical and microbiological periodontal disease among adult Sardinians. A total of 212 individuals participated in this study: 71 T2DM patients aged 61.0 +/- 11.0 years and 141 non-diabetic controls in good general health aged 59.1 +/- 9.2 years. All subjects were given a clinical periodontal examination for probing depth, attachment level, presence of calculus, bleeding on probing, and assessment of plaque. Subgingival plaque samples were obtained, and P. gingivalis, P. intermedia, and T. forsythensis were identified using multiplex polymerase chain reaction. T2DM patients showed a significantly lower number of teeth present (P = 0.002); a significant increase in number of probing depths >4 mm, and percent of pocket depths >4 mm (P = 0.04 and P = 0.05, respectively); periodontitis (P = 0.046); bleeding on probing (P = 0.02); and plaque index (P = 0.01). A significant association with diabetes was detected for plaque (X2= 4.46; P <0.05) and bleeding on probing (X2= 3.60; P <0.05). Concerning bacteria prevalence, a positive association was detected for P. gingivalis (X2= 2.80; P <0.05) and T. forsythensis (X2= 3.87; P <0.05). Presence of plaque was positively associated with case status (odds ratio [OR] = 1.3; 95% confidence interval [CI]: 1.2, 3.6) and with prevalence of P. gingivalis and T. forsythensis (OR = 1.2, 95% CI: 1.3, 2.2; and 1.2, 95% CI: 1.2, 1.8, respectively). Patients with T2DM undoubtedly have a susceptibility for more severe periodontal disease.

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Journal

Journal ID (publisher-id): rom

Title: Revista odontológica mexicana

Abbreviated Title: Rev. Odont. Mex

Publisher: Universidad Nacional Autónoma de México, Facultad de Odontología (México, DF, Mexico )

ISSN (Print): 1870-199X

Publication date (Print and electronic): March 2014

Volume: 18

Issue: 1

Pages: 27-31

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[01] orgnameUniversidad Nacional Autónoma de México orgdiv1Facultad de Odontología orgdiv2División de Estudios de Postgrado e Investigación

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Publisher ID: S1870-199X2014000100006 Publisher ID: S1870-199X(14)01800100006

SO-VID: 2128364e-e5e6-464c-8018-24fc640a1a0b

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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Tratamiento multidisciplinario en una paciente con periodontitis agresiva generalizada y diabetes mellitus tipo 1 Translated title: Multi-disciplinary treatment of female patient afflicted with generalized aggressive periodontitis and type 1 diabetes mellitus

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SciELO Mexico

Most cited references 42

The efficacy of bone replacement grafts in the treatment of periodontal osseous defects. A systematic review.

Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis: a randomized placebo-controlled clinical trial.

Diabetes and periodontal disease: a case-control study.

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