Impact of pediatric hematopoietic stem-cell transplantation on craniofacial growth

OBJECTIVES: To assess the craniofacial skeletal growth in pediatric hematopoietic stem-cell transplantation (HSCT) survivors in comparison with age-sex matched-paired controls. METHODS: A case-controlled retrospective comparison of the craniofacial growth in 25 HSCT children and 25 matched-paired controls was conducted. Craniofacial growth was quantitatively assessed by linear and angular measurements in panoramic radiographic images using ImageJ¯. Stature growth and body weight were obtained through physical examination. Cancer diagnosis, myeloablative conditioning, and HSCT were retrieved from medical records. RESULTS: Patients aged 12.2 years (±3.8; 16 male, 9 female). Radiographic images were obtained on an average of 2.43 (±2.0) years after HSCT. The main malignant diagnosis was acute lymphoblastic leukemia (56%), followed by acute myeloid leukemia (36%) and myelodysplastic syndromes (8%). Total body irradiation was associated with chemotherapy at 80%. Mean age at transplantation was 10 (±4.7) years. HSCT survivors showed reduced a vertical growth of the mandibular ramus (p=0.003). This persisted among individuals below 12 years of age (p=0.017). The HSCT group showed delayed dental eruption, though there was no statistically significant difference (p=0.3668). The HSCT group showed stature deficit, increased weight, and body mass index (Z-score stature: -0.28; Z-score weight: 0.38, respectively). CONCLUSIONS: Pediatric HSCT has decreased vertical craniofacial growth compared to their matched controls. There might be an association between reduced craniofacial vertical growth and reduced estature growth. Further studies to quantitatively investigate the impact of different myeloablative regimens in craniofacial skeletal growth and development.

Mandibular radiomorphometric assessment of bone mineral density in survivors of pediatric hematopoietic stem-cell transplantation

OBJECTIVE: Hematopoietic stem-cell transplantation (HSCT) childhood survivors of hematologic malignancies are prone to develop late osteopenia and osteoporosis. The purpose of this retrospective study was to quantitatively and qualitatively assess bone mineral density (BMD) in HSCT childhood survivors and to compare the effectiveness of both qualitative and quantitative assessment methods. METHODS: DESIGN BMD assessment using panoramic radiographs of childhood HSCT survivors aged 3.69-18.88 years using two radiomorphometric indexes. Case-control double-blinded comparison of panoramic radiographic images from childhood HSCT survivors and age- and sex-matched healthy controls. Quantitative assessment was performed by measuring the cortical bone width bilaterally at the mental foramen level. Qualitative assessment was performed using the mandibular cortical index bilaterally on all panoramic images. RESULTS: Radiographs were taken 6.59-83.95 months after bone marrow transplantation [median±SD=25.92±24.9 months]. Fifty-two panoramic radiographic images were analyzed: 21 from HSCT survivors and 31 from healthy controls aged 3.69-25.1 years [mean±SD=11.89±5.28 years]. The mandibular cortical bone width was 17% smaller in childhood HSCT survivors than in healthy controls (case group: 2.420, control group: 3.307; p=0.00617). Qualitative analysis revealed an increased frequency of severe mandibular cortical erosion in childhood HSCT survivors, although no significant difference was observed (case group: 1.540, control group: 1.490; p=0.32). The interobserver agreement was 85% (Kappa index). CONCLUSIONS: HSCT childhood survivors exhibit quantitative and qualitative mandibular bone impairments. Further studies are needed to establish an association between mandibular cortical bone impairment and osteoporosis.

Comparative analysis of different prophylactic methods for roughness of primary tooth enamel / Análise comparativa de diferentes métodos profiláticos sobre a rugosidade do esmalte em dentes decíduos

Objective: The purpose of this study was to comparatively evaluate quantitative effects of three different prophylactic methods of surface polishing treatments for primary teeth compared to a standardized control group. Material and Methods: 48 naturally exfoliated primary teeth were selected and randomly assigned into four groups: Control Group ­ teeth receiving only enamel standardization treatment with polishing disc to reduce natural enamel; Group I ­ teeth receiving superficial enamel standardization treatment followed by polishing with a mixture of water and pumice; Group II ­ teeth receiving enamel standardization treatment followed by prophylaxis with paste (Herjos-F, Vigodent S/A Indústria e Comércio, Rio de Janeiro, Brazil); and Group III ­ teeth receiving enamel standardization treatment followed by sodium bicarbonate spray (Profi II Ceramic, Dabi Atlante Indústrias Médico-Odontológicas Ltda, Ribeirão Preto, Brazil). All the procedures were performed by the same operator and the samples were rinsed and stored in distilled water. Comparative assessment of the enamel surface roughness between experimental groups and control group was performed by using a surface profilometer (Mitutoyo SJ400). Results: The results of this study were statistically analysed by using Minitab statistical software (version 17.1.0, 2013). The use of pumice and water led to significantly rougher surfaces than in other groups (i.e. Group I: 1.22 Ra; Group II 0.38 Ra; Group III: 1.01 Ra). Conclusion: Based on this study, one can conclude that use of pumice and water resulted in increased enamel surface roughness in comparison to the surface treatment with bicarbonate spray and prophylaxis paste. (AU)

Objetivos: O objetivo deste estudo foi quantificar e comparar a rugosidade do esmalte dentário após de três diferentes tratamentos profiláticos para polimento de superfície de esmalte em dentes decíduos, em relação a um grupo controle. Material e Métodos: 48 dentes decíduos naturalmente esfoliados foram selecionados e alocados aleatoriamente em quatro grupos. Grupo Controle: recebeu apenas padronização do esmalte através do disco de polimento para redução de dentes naturais. O grupo I recebeu padronização superficial do esmalte seguido de polimento por mistura de água e pedra-pomes; o grupo II recebeu padronização do esmalte seguido da pasta de profilaxia Herjos-F (Vigodent S / A Indústria e Comércio, Rio de Janeiro, Brasil); e o grupo III recebeu padronização da superfície do esmalte seguido de spray de bicarbonato de sódio Profi II Ceramic (Dabi Atlante Indústrias Médico Odontológicas Ltda., Ribeirão Preto, Brasil). Todos os tratamentos de superfície foram realizados pelo mesmo operador, por dez segundos e as amostras foram lavadas e armazenadas em água destilada. A avaliação comparativa da rugosidade superficial do esmalte entre os grupos experimentais e controle foi realizada utilizando-se um perfilômetro de superfície Mitutoyo SJ400. Resultados: Os resultados deste estudo foram analisados estatisticamente com o software estatístico Minitab (versão 17.1.0, 2013). A pedra-pomes e a água geraram significativamente maior aspereza na superfície de esmalte, em comparação aos outros grupos, quando empregado o teste estatístico de Tukey (Grupo I: 1,22 Ra; Grupo II: 0,38 Ra; Grupo III: 1,01 Ra). Conclusão: Com base neste estudo, pode-se concluir que a pedra-pomes e a água resultaram em aumento da rugosidade superficial do esmalte em comparação ao tratamento superficial com spray de bicarbonato e pasta profilática.(AU)

Review of a three-year study on the dental care of onco-hematological pediatric patients

The aim of this study was to provide an updated review of dental procedures undertaken at the dental unit of the Onco-hematology service of the Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (ICr/HC-FMUSP). We retrospectively reviewed 565 of 1902 medical and dental records of patients diagnosed with onco-hematological diseases who were seen in a 3-year study (January 2015 to December 2017). We assessed data regarding population characteristics, onco-hematological diagnosis and dental procedures performed. Of the selected medical records, preventive dentistry was the most common procedure undertaken in this population, followed by oral maxillofacial surgeries, restorative dentistry and oral mucositis treatment. The most prevalent malignant diagnosis was acute lymphocytic leukemia, and the most prevalent nonmalignant diagnosis was sickle-cell anemia. Preventive dental procedures represent most of the dental procedures undertaken in hospitalized onco-hematological pediatric patients.

Long-term dental follow-up in hematological stem cells transplantation children / Acompanhametnto a longo prazo das alterações dentárias em pacientes pediátricos submetidos ao transplante de celulas tronco hematopoieticas

The aim of this paper is to update the current published content about the craniofacial long-term development disturbances of childhood hematopoietic stem-cell transplantation (HSCT) and the preparative regimens for the onco-hematological malignancies treatments. Methods: Two author sindependently reviewed the published articles about long-term effects of childhood HSCT that fitted into predetermined inclusion/exclusion criteria: clear definition of exposure or intervention, standard outcomes measurement and appropriate statistical analysis. Results: Twelve papers matched all the previous established eligibility criteria and were included in this review. The children’s age at HSCT were related to a higher risk of dental development disturbances, such as agenesis, dental hypoplasia, root stunting, crown-root proportion alterations, and microdontia. Craniofacial vertical growth was impaired in the irradiated patients without antero-posterior or latero-lateral impairment. Temporomandibular joint dysfunction was found to be more prevalent in the patients diagnosed withgraft-versus-host disease. Conclusion: The late effects of craniofacial development disturbances lead to several aesthetic and functional impairment, periodontal bone resorption with consequent impairment of chewing ability, and risk of early tooth loss often associated with life’s quality impairment. Further investigations should be performed to provide accurate information for patients, parent sand health care professionals...

Este artigo visa revisar o conteúdo publicado sobre as alterações tardias em crianças submetidas ao transplante de células-tronco hematopoiéticas(TCTH) e o regime pré-transplante para tratamento das doenças onco-hematológicas. Método: Dois autores independentes conduziram uma revisão simples dos artigos recentemente publicados sobre o tema, utilizando os critérios de exclusão/inclusão pré determinados: definição clara da intervenção clínica realizada, mensuração dos resultados padronizada e análise estatística adequada. Resultados: Doze artigos enquadraram-se em todos os critérios de avaliação pré-determinados para esta revisão. Houve correlação entre a idade da criança no momento do TCTH e maior risco de distúrbios de desenvolvimento dentário, como agenesia, hipoplasia dentária, encurtamento radicular,alterações da proporção coroa-raiz e microdontia.Houve alteração do crescimento craniofacial no sentido vertical sem, no entanto, alterar o crescimento anteroposterior e latero-lateral. Disfunção da articulação temporomandibular foi mais prevalente entre os pacientes com diagnostico de Doença do Enxerto contra o Hospedeiro. Conclusão: Os efeitos tardios do desenvolvimento craniofacial podem levara diversas alterações estéticas e funcionais, reabsorção óssea periodontal, diminuição da capacidade de mastigação e perda dentária precoce com possíveis impactos negativos sobre a qualidade de vida. Mais estudos são necessários para fornecer informações precisas aos pacientes, cuidadores e profissionais de saúde...

Aqueous-ozone irrigation of bone monocortical wounds in hyperglycemic rats

PURPOSE: To analyze the effects of aqueous ozone irrigation over bone healing in hyperglycemia-induced rats. METHODS: Forty-eight male Wistar rats were allocated into Group H (hyperglycemic) or Group N (control). Monocortical bone wound were performed on femurs' anterolateral face. Wounds were treated with a trans-operatory single irrigation of 100ml of aqueous ozone [0.004mg/ml] whereas control groups received 100ml of pure water (Milli-Q®). Histomorphological and histomorphometrical analyses were accomplished after seven, 14 and 21 days. Kruskal-Wallis and Mann-Whitney statistical tests were applied for bone neoformation quantification and assessment. RESULTS: Aqueous ozone wounds irrigated revealed diffuse hemorrhage and increased neoformed of blood vessels number. There was no statistical significant difference in bone trabeculae neoformation. After seven and 14 days, the number of osteoclasts was higher in aqueous ozone groups than in those treated with pure water. CONCLUSION: Independently of blood glucose levels, aqueous ozone allowed an increase in blood vessels neoformation and osteoclast migration, without affect bone trabeculae neoformation.

Diabetes mellitus, reparação óssea e osseointegração / Diabetes mellitus, bone remodeling, and osseointegration

A instalação de implantes dentários é um procedimento cirúrgico utilizado para reabilitação funcional e estética em pacientes de diferentes idades, gêneros e condições de saúde. O processo de osseointegração depende primordialmente que a reparação dos tecidos ósseos ocorra na ausência de interferências negativas. As condições sistêmicas observadas nos pacientes diabéticos descompensados causam comprometimento da reparação tecidual, alta susceptibilidade a infecções e complicações microvasculares que podem contraindicar a instalação de implantes metálicos. Entretanto, devido à expansão da prevalência do diabetes mellitus é maior o número de portadores desta doença que necessitam de implantes osseointegrados. A literatura sobre o comprometimento da reparação dos tecidos ósseos observado no diabetes é extensa e está relacionada ao desequilíbrio entre a produção, o metabolismo e o equilíbrio de moléculas reativas de oxigênio. A hipoinsulinemia e a hiperglicemia seriam as principais complicações responsáveis pelos distúrbios no processo reparativo. Objetivando descrever os principais aspectos do diabetes e sua correlação com a reparação óssea e a osseointegração, uma revisão da literatura é apresentada

Dental implants have become the therapy of choice for functional and esthetic rehabilitation in patients of different ages, gender, and health status. Implant osseointegration is primarily dependent on bone tissue repair that should occur in the absence of negative interferences. Systemic conditions observed in the non-controlled diabetic patient cause tissue repair impairment, high susceptibility to infections, and microvascular complications that may contraindicate the installation of metallic implants. However, the ongoing prevalence of diabetes mellitus increases the number of patients with this disease who require dental implants. Literature on bone tissue repair and Diabetes is extensive and related to the imbalance between production, metabolism, and action of reactive oxygen molecules. Hypoinsulinemia and hyperglicemia are the main causes of healing disturbances. Aiming to describe the main aspects of diabetes and their correlation with bone healing and osseointegration, a review of the literature is presented