Efeito da frequência do autocontrole mecânico de placa nas condições gengivais de pacientes com histórico de periodontite e em manutenção periodontal

Abstract

The present thesis was structured in two scientific articles that investigated the effect of self-performed mechanical plaque control frequencies on supra and subgingival parameters of patients with a history of periodontitis and periodontal maintenance. The first article aimed to evaluate the effect of different frequencies on self-performed mechanical plaque control (SPC) on the gingival health of individuals with a history of periodontitis, treated and participants in a periodontal maintenance program. Forty-two individuals with a history of periodontitis and periodontal maintenance participants (maximum 7.5% of sites with gingival bleeding) were randomized to different frequencies of SPC: 12, 24 and 48 hours. Plaque index (PlI) and gingival index (GI) were evaluated at the baseline, 15, 30 and 90 days. Probing depth, attachment level and bleeding on probing were assessed at the baseline, 30 and 90 days. Mixed linear models were used for the analysis and comparison of experimental groups. The mean GI between baseline and 90 days remained unchanged only in the 12h group (0.74 ± 0.057 versus 0.85 ± 0.059). Just in the 48h group was there an increase in the GI means throughout the experimental period, already showing significant differences between baseline and 15 days (P<0.05). At the end of the trial period, the GI means were significantly higher in the 48-hour group than in the 12 and 24-hour groups (P<0.05). When the percentage of GI=2 were considered, only the 48h group could not maintain gingival health at the end of the experimental period (18.83%) (P<0.05). SPC performed every 12 to 24 hours was compatible with the maintenance of gingival health in individuals with a history of periodontitis, treated, and participants in a periodontal maintenance program. The second article aimed to elucidate how the different frequencies of SPC interfere in the subgingival inflammatory parameters by evaluating the correlation between gingival bleeding (GI=2) and bleeding on probing (BoP) in the different groups of SPC in individuals with a history of periodontitis. Forty-two individuals with a history of periodontitis and periodontal maintenance participants (maximum 7.5% of sites with gingival bleeding) were randomized to different frequencies of SPC: 12, 24 and 48 hours. Gingival index and bleeding on probing were evaluated at baseline, 30 and 90 days. Intragroup differences were determined using repeated measures ANOVA. Intergroup differences in the baseline were verified using a chi-square test and independent t-test. The Spearman correlation coefficient between GI and BoP for the different groups was calculated at the baseline, 30 and 90 days. Significant changes in correlation were observed between baseline and 90 days for the 48h group. Statistically significant positive correlations were found between the GI means and BoP in all groups and increased throughout the experimental period, but only 48h group presented a moderate correlation between GI and BoP at 90 days (r=0.34) (P<0.01). When the correlation between GI and SS was evaluated in shallow pockets (PD≤3 mm), at 30 days all groups had a statistically significant positive correlation and only in the 48h group the correlation was moderate (r=0.31) (P<0.01). At the end of 90 days, there was a decline in correlation in the 12h group, and an increase in the other groups, a moderate correlation in the 48h group (r=0.36) and weak in the different experimental groups (P<0.01). The performance of the SPC every 48 hours resulted in a significant increase in the GI=2 mean compared to the other groups. These marginal inflammatory changes had repercussions on the subgingival environment through an increase in bleeding on probing, demonstrated by the moderate statistically significant correlation between GI=2 and BoP in this experimental group.