Carcinoma cell-derived chemokines and their presence in oral fluid.

Chemokines are important in inflammation and in carcinogenesis. We hypothesized that besides oro-laryngeal cancer, oral inflammatory states, such as periodontitis, may also influence the chemokine profile of oral fluid. The aim of this study was to characterize the chemokine isoforms in the oral fluid of patients with periodontitis and in the oral fluid of patients with head and neck cancer. Using enzyme-linked immunosorbent assays (ELISA), it was found that the concentrations of CXCL8, CXCL10, and CCL14 were significantly elevated in the oral fluids of the cancer patients. However, periodontitis did not significantly alter the chemokine levels in oral fluid. Identification of chemokine isoforms by a proteomic approach using a newly developed three-step purification procedure was applied on the oral fluid of head and neck cancer and periodontitis patients and on the conditioned medium from carcinoma cells. Carcinoma cells produced predominantly intact CXCL1, CXCL2, CXCL8, and CCL2, whereas CXCL8 also appeared in a truncated, more active, form. Unfortunately, the chemokine concentrations in oral fluids were too low to allow full biochemical identification of the modified isoforms. However, the chemokine profile of head and neck cancer significantly changed after therapy, indicating that it is a useful parameter in clinical practice.

Bone healing after dental extractions in irradiated patients: a pilot study on a novel technique for volume assessment of healing tooth sockets.

The aim of this study was to evaluate longitudinally the bone-healing process by measuring volumetric changes of the extraction sockets in head and neck cancer patients undergoing radiotherapy after tooth extraction. A total group of 15 patients (nine males, six females) undergoing tooth extraction at the Department of Periodontology (University Hospital KULeuven) were enrolled after giving informed consent. In seven patients, teeth presenting a risk for complications and eventual radionecrosis were extracted prior to the radiotherapeutical procedure. Monitoring of bone healing was performed by evaluating the volumetric changes of the alveoli by cone beam CT scanning (CBCT) at extraction and after 3 and 6 months. In parallel, a similar longitudinal evaluation of extraction sites was done in a control group of eight patients. Within this pilot-study, a total of 15 healing extraction sockets were evaluated and followed up. There was a significant difference in volumetric fill up of extraction sockets in test group vs. control group at three (37.1 +/- 7.9%) vs. (54.6 +/- 4.0%) and 6 months (47.2 +/- 8.8%) vs. (70.0 +/- 7.3%), respectively. The present pilot study demonstrated the clinical usefulness of CBCT for evaluation of extraction socket healing. The study objectively demonstrates the delayed bone healing after tooth extraction in irradiated head and neck cancer patients. Considering the limitations of this pilot study, a potential effect of radiotherapy on further jaw bone healing after pre-therapeutic tooth extractions should be further explored.

Volumetric analysis of extraction sockets using cone beam computed tomography: a pilot study on ex vivo jaw bone.

AIM: The aim of this study was to determine the accuracy of volumetric analysis of extraction sockets using cone beam computed tomography (CBCT). MATERIAL AND METHODS: The volume of 40 dental alveoli in nine dry skull specimens (four mandibles and five maxillae) was determined by measuring the volume of the tooth socket impression using the water displacement technique. This was considered as the gold standard. Then, the tooth socket was scanned with CBCT and data were uploaded in the semi-automated Livewire segmentation software. The software segments the tooth socket in consecutive 1 mm-thick two-dimensional slices. After segmentation, the total volume of the delineated socket was computed. The statistical difference between direct volumetric measurements and those obtained with CBCT imaging was assessed using the Student paired t-test. RESULT: The mean socket volume of the skull specimens was 227+/-91 mm(3) when obtained by direct measurement and 225+/-90 mm(3) when obtained by CBCT imaging. Student paired t-test showed no significant differences between both volume measurements (p>0.1). CONCLUSIONS: CBCT permits imaging of anatomical structures in three planes and allows for reliable volume estimates. The results should be verified in clinical circumstances and might have potential applicability for evaluation of extraction socket healing under different conditions.

A biomechanical assessment of the relation between the oral implant stability at insertion and subjective bone quality assessment.

AIM: The study was set to evaluate the validity of subjective jaw bone quality assessment. MATERIALS AND METHODS: A total of 298 patients (198 females, mean age 56.4) were treated with oral implants at the Periodontology Department at the University Hospital of KUL. A total of 761 TiUnite implants have been installed. Subjective bone quality assessment was performed on radiographs and by the surgeon's tactile sensation and was compared with torque measurements. In a subset of patients, implant stability was also assessed by implant stability quotient and/or periotest values. RESULTS: Subjective assessment of bone quality was related to the PTV, ISQ and placement torque [in the crestal, the second and the apical third (N cm)], respectively; in grade 1: -5.3, 73.3 (4.2, 9.6, 15.2), and grade 3 or 4: -1.6, 55 (3.3, 5.5, 8.4). For the surgeon's tactile sensation, a good correlation was noted for the presence of a thick cortex: -4.6, 70.3 (4.2, 9.7, 15.1), or a thin one: -0.3, 65.9 (3.6, 6.9, 10.1). For dense trabecular bone, the values were -2.8, 69.4 (4.4, 9.7,14.8), while for poor trabecular bone, the values were-1.7, 66.4 (3.6, 6.4, 9.8). CONCLUSIONS: Subjective assessment of bone quality is related to PTV, ISQ and placement torque measurements at implant insertion.

Comparison between jaw bone augmentation by means of a stiff occlusive titanium membrane or an autologous hip graft: a retrospective clinical assessment.

OBJECTIVES: Patients in need of bone augmentation procedures can be treated with a traditional hip graft or by neogenesis under a stiff occlusive titanium membrane, custom-fit on the basis of CT-scan data. MATERIAL AND METHODS: Eighteen patients treated by means of a hip graft (H) were compared with 11 patients using a full titanium membrane (M) for the rehabilitation of upper jaws. In the H group, 17 patients (62 implants) in the anterior region (Ha) and 14 patients (23 implants) in the posterior region (Hp) were included. In the M group, nine patients (30 implants) in the anterior region (Ma) and seven patients (16 implants) in the posterior region (Mp) were included. RESULTS: In group Ha, the CFR was 13.3% after 14 years compared with group Ma where the CFR was 17.4% after 9 years. In group Hp, the CFR was 22.8% after 16 years compared with group Mp where the CFR was 23.4% after 6 years. The marginal bone loss for group Ha after 20 years was 2.7 mm, for group Ma it was not even 1 mm after 9 years; for group Hp, it was 2.5 mm after 15 years compared with less than 1 mm after 3 years in group Mp. CONCLUSIONS: The success rate of alveolar ridge augmentation therapy is lower than in a classical approach. These augmentation procedures, however, show acceptable results. The titanium membrane augmentation leads to less marginal bone loss probably because neo-formed bone has a better chance to adapt its mineralization to occlusal forces encountered. This technique could offer improvement if membrane exposure can be avoided.