[Clinical, biochemical and histopatological correlación in diabetic patiens with periodontal disease]

INTRODUCTION

The aim of this paper was to study the clinical, biochemical and histopathological correlation caused by scaling and root planning in diabetic patients with periodontal disease.

MATERIAL AND METHODS

The study was conducted on 80 patients, both males and females, (age 25-60 years). Fourty patients had type 1 and type 2 diabetes, while 40 were non-diabetic patients. According to the medical examination, the subjects including in the study were well-compensated. After studying the periodontal field, patients with real pockets measuring 5 mm or less were selected. LABORATORY CRITERIA: The subjects were considered to be diabetic when their basal glycemia was equal to or above 140 mg/dl, and the HbA1C equal to or above 8%. Patients whose glycemia was below 115 mg/dl, and their HbA1C below 8% were considered to be non-diabetic. Free and inserted biopsies of the gingiva were done after the administration of 2 g of amoxicilin. Scaling and planing of all the teeth was carried out and periodontal protection was placed. Supervised dental sessions were held weekly. Clinical and biochemical criteria for selection were used again at 40 days and at 120 days. Biopsies were done and analyzed microscopically.

RESULTS

At 40 days and mainly at 120 days it was found that in 90% of the selected patients glycemia values had decreased. In 70% of the cases studied HbA1C values were stable and the clinical signs of the periodontal disease were reversed in 80% of the subjects. Histological analysis at time 0 revelead mononuclear infiltrate, congestion and proliferation of the middle layer of the vessels when compared with non-diabetic values with deposits of PAS + material. At 40 days and at 120 days there was also a decreased of infiltrate and of the deposits PAS + on the wall of the small vessels.

CONCLUSION

Scaling and planning is proposed as an effective method to reverse glycemic values, HbA1C, gingival microangiopathies and clinical signs in diabetic patients with periodontal disease.

Human suprabony healing responses following root demineralization and coronal flap anchorage. Histologic responses in 7 sites

6 suprabony pockets in 2 adult patients were treated with debridement and citric acid root demineralization. Following these procedures, coronal positioning of the marginal flaps was performed at 2 sites. At 4 sites, the marginal flaps were sutured coronally using orthodontic brackets as anchors. At 1 additional site, root debridement only was performed and the margin was placed at about crestal level. Prior to root planing, all roots were notched both at the level of the gingival margin and the most apically positioned calculus. Blocks were harvested 7 and 18 weeks postsurgery and prepared for histologic analysis. Clinical results showed a gain in probing attachment in both coronally positioned sites (average = 1.8 mm) and coronally anchored sites (average = 4.5 mm). The additional debrided-only site showed a gain in probing attachment of 0.1 mm. Histologically, new cementum with functionally inserted fibers was seen within the calculus notch in all coronally anchored sites. This new attachment was associated with crestal osteogenesis. In the 2 coronally positioned and root demineralized sites, new attachment was seen within the calculus notch in 1 out of the 2 specimens evaluated. Within the limits of the evidence presented, coronal anchorage of flaps enhanced probing attachment and new attachment when used in conjunction with root demineralization.