Expression of inflammatory mediators in periodontitis and T2D patients: a systematic review and meta-analysis.

The high concentration of glucose in the blood in Type 2 diabetes (T2D) may be related to either insulin resistance or insulin deficiency. Moreover, the literature points to periodontitis as the main oral disease caused by glycemia imbalance. The quantification of inflammatory markers in blood or saliva samples of T2D patients may represent a valuable tool in revealing how well an individual's immune system can respond to injuries and periodontal treatment. In addition, an evaluation of the cytokine expression is extremely relevant to help understand the connection between periodontitis and T2D. This systematic review and meta-analysis aimed to evaluate the expression of inflammatory markers in T2D patients with periodontitis, compared with non-diabetic patients with periodontitis. A total of 3,894 studies were retrieved after a systematic literature search, 15 of which were included in the systematic review, and 4 of these 15, in the meta-analysis. The results did not indicate any statistical difference between the groups regarding TNF-α and IL-6 markers. T2D patients with periodontitis had increased levels of IL-10, compared with non-diabetic individuals with periodontitis (p = 0.003). On the other hand, the IL-4 concentration in non-diabetic individuals with periodontitis was high, compared with the T2D group (p< 0.001). Several studies did not include quantitative results and were excluded from the meta-analysis. The high IL-10 expression and low IL-4 expression in the T2D group suggest an association between the level of these markers and the impairment of the immune response in T2D patients with periodontitis.

Guided endodontic treatment in a region of limited mouth opening: a case report of mandibular molar mesial root canals with dystrophic calcification.

BACKGROUND: The endodontic treatment of calcified root canals in molars is a challenging and time-consuming procedure. Even with the aid of a surgical microscope, the risk of root perforation is high, especially in the furcation area. The purpose of this study is to report the Computer-Aided-Design and Manufacturing (CAD-CAM) workflow, the innovative strategies for the template ideation, and the guided endodontic treatment of a mandibular molar with dystrophic calcification in the mesial root canals. CASE PRESENTATION: A 58-year-old female patient, ASA I, was referred to endodontic treatment in the right first mandibular molar for prosthetic reasons. The mesiobuccal and mesiolingual canals appeared obliterated in the radiographic images. The absence of dental crown, tooth inclination, and the limited mouth opening of the region contributed to a poor visual reference of the tooth in the dental arch and the direction of the remaining lumens of the canals. Despite using surgical microscopy, the conventional technique led to the deviation of the mesiobuccal canal towards the furcation area. The obliteration of both mesial root canals was confirmed using the Cone Beam Computer Tomography. The clinical history associated with the tomography diagnosis was compatible with dystrophic calcifications in the pulp canals. The patient was submitted to an intra-oral scanning as well. The Digital Imaging and Communications in Medicine data (DICOM) were segmented. The Standard Tessellation Language (STL) files were processed following the CAD-CAM workflow, aiming to create two different endodontic templates with a new open design concept. The templates with open design allowed direct visualization of the operative field, irrigation, and dentin debris removal. The strategy of the guidance sleeves niche as half-cylinders allowed the drill insertion in a limited mouth opening region. CONCLUSIONS: The digital planning and guided access permitted to overcome the case limitations and then re-establish the glide path following the original anatomy of the root canals. The guided endodontic represents a personalized technique that provides security, reduced risks of root perforation, and a significant decrease of the working time to access obliterated root canals even in the mesial root canal of mandibular molars, a region of limited mouth opening.

The Complex Interrelationship between Diabetes Mellitus, Oral Diseases and General Health.

There is emerging evidence that several oral diseases and conditions can be associated with DM. Dental caries, hyposalivation, fungal diseases and endodontics lesions may represent potential oral complications that can be aggravated by chronic hyperglycemia. Individuals with DM have a low perception of oral diseases which can lead to clinically important oral and systemic complications. This review aims to provide data on the most common oral signs and symptoms related to DM and to explore the mechanisms that might explain associations between DM and oral diseases in order to clarify the risks posed by poor oral health in DM. Since the linkage between oral diseases and DM is part of multifactorial aspects related to chronic hyperglycemic status and several common conditions affecting the whole body, both require rigorous self-control from patients and attention from medical and dental professionals.

Expression of inflammatory mediators in periodontitis and T2D patients: a systematic review and meta-analysis

Abstract The high concentration of glucose in the blood in Type 2 diabetes (T2D) may be related to either insulin resistance or insulin deficiency. Moreover, the literature points to periodontitis as the main oral disease caused by glycemia imbalance. The quantification of inflammatory markers in blood or saliva samples of T2D patients may represent a valuable tool in revealing how well an individual's immune system can respond to injuries and periodontal treatment. In addition, an evaluation of the cytokine expression is extremely relevant to help understand the connection between periodontitis and T2D. This systematic review and meta-analysis aimed to evaluate the expression of inflammatory markers in T2D patients with periodontitis, compared with non-diabetic patients with periodontitis. A total of 3,894 studies were retrieved after a systematic literature search, 15 of which were included in the systematic review, and 4 of these 15, in the meta-analysis. The results did not indicate any statistical difference between the groups regarding TNF-α and IL-6 markers. T2D patients with periodontitis had increased levels of IL-10, compared with non-diabetic individuals with periodontitis (p = 0.003). On the other hand, the IL-4 concentration in non-diabetic individuals with periodontitis was high, compared with the T2D group (p< 0.001). Several studies did not include quantitative results and were excluded from the meta-analysis. The high IL-10 expression and low IL-4 expression in the T2D group suggest an association between the level of these markers and the impairment of the immune response in T2D patients with periodontitis.

Oral Phenotype and Salivary Microbiome of Individuals With Papillon-Lefèvre Syndrome.

Papillon-Lefèvre syndrome (PLS) is an autosomal recessive rare disease, main characteristics of which include palmoplantar hyperkeratosis and premature edentulism due to advanced periodontitis (formerly aggressive periodontitis). This study aimed to characterize the oral phenotype, including salivary parameters, and the salivary microbiome of three PLS sisters, comparatively. Two sisters were toothless (PLSTL1 and PLSTL2), and one sister had most of the teeth in the oral cavity (PLST). Total DNA was extracted from the unstimulated saliva, and the amplicon sequencing of the 16S rRNA gene fragment was performed in an Ion PGM platform. The amplicon sequence variants (ASVs) were obtained using the DADA2 pipeline, and the taxonomy was assigned using the SILVA v.138. The main phenotypic characteristics of PLS were bone loss and premature loss of primary and permanent dentition. The PLST sister presented advanced periodontitis with gingival bleeding and suppuration, corresponding to the advanced periodontitis as a manifestation of systemic disease, stage IV, grade C. All three PLS sisters presented hyposalivation as a possible secondary outcome of the syndrome. Interestingly, PLST salivary microbiota was dominated by the uncultured bacteria Bacterioidales (F0058), Fusobacterium, Treponema, and Sulfophobococcus (Archaea domain). Streptococcus, Haemophilus, and Caldivirga (Archaea) dominated the microbiome of the PLSTL1 sister, while the PLSTL2 had higher abundances of Lactobacillus and Porphyromonas. This study was the first to show a high abundance of organisms belonging to the Archaea domain comprising a core microbiome in human saliva. In conclusion, a PLST individual does have a microbiota different from that of the periodontitis' aggressiveness previously recognized. Due to an ineffective cathepsin C, the impairment of neutrophils probably provided a favorable environment for the PLS microbiome. The interactions of Bacteroidales F0058, Caldivirga, and Sulfophobococcus with the microbial consortium of PLS deserves future investigation. Traditional periodontal therapy is not efficient in PLS patients. Unraveling the PLS microbiome is essential in searching for appropriate treatment and avoiding early tooth loss.

Calcium silicate-based cements cause environmental stiffness and show diverse potential to induce osteogenesis in human osteoblastic cells.

Calcium silicate-based cements differ markedly in their radiopacifiers and the presence of calcium sulfate, aluminates, carbonates and other components that can affect their biological properties. This study aimed to compare the biological properties of six calcium silicate cements in human osteoblastic cell culture (Saos-2 cells): Bio-C Repair (Bio-C), PBS HP (PBS-HP), Biodentine (Biodentine), MTA Repair HP (MTA-HP), NeoMTA Plus (NeoMTA-P), and ProRoot MTA (ProRoot). After exposure to these materials, the cells were analyzed by MTT, wound healing, cell migration, and alkaline phosphatase activity (ALP) assays, real-time PCR (qPCR) analysis of the osteogenesis markers (osteocalcin or bone gamma-carboxyglutamate protein, BGLAP; alkaline phosphatase, ALPL; bone sialoprotein or secreted phosphoprotein 1, BNSP), and alizarin red staining (ARS). Curiously, the migration rates were low 24-48 h after exposure to the materials, despite the cells showing ideal rates of viability. The advanced and intermediate cell differentiation markers BGLAP and BNSP were overexpressed in the Bio-C, MTA-HP, and ProRoot groups. Only the Biodentine group showed ALPL overexpression, a marker of initial differentiation. However, the enzymatic activity was high in all groups except Biodentine. The mineralization area was significantly large in the NeoMTA-P, ProRoot, PBS-HP, MTA-HP, and Bio-C groups. The results showed that cellular environmental stiffness, which impairs cell mobility and diverse patterns of osteogenesis marker expression, is a consequence of cement exposure. Environmental stiffness indicates chemical and physical stimuli in the microenvironment; for instance, the release of cement compounds contributes to calcium phosphate matrix formation with diverse stiffnesses, which could be essential or detrimental for the migration and differentiation of osteoblastic cells. Cells exposed to Bio-C, PBS-HP, ProRoot, NeoMTA-P, and MTA-HP seemed to enter the advanced or intermediate differentiation phases early, which is indicative of the diverse potential of cements to induce osteogenesis. Cements that quickly stimulate osteoblast differentiation may be ideal for reparative and regenerative purposes since they promptly lead to dentin or bone deposition.

Lesions of the Parotid Gland and Buccal Artery After Buccal Fat Pad Reduction.

The significant increase in esthetic surgery, especially buccal fat pad reduction, has led to a corresponding increase in lesions and postoperatory after-effects from this surgical procedure. The aim of this study is to discuss the immediate and mediate risks of removing the Bichat ball, as well as describing a clinical study in which this surgical procedure resulted in lesions of the parotid gland and buccal artery, which was confirmed via nuclear magnetic resonance. The facial lesions were remedied via exploratory surgery by opening a new orifice of the glandular duct in the buccal cavity followed by drainage and compressive surgical bandages.

Fusão de imagem 3D do complexo craniomaxilofacial – ferramenta para simulação virtual do tratamento ortodôntico-ortognático / Fusion of 3D image of cranio-maxillofacial complex: tool for virtual simulation of orthodontic-orthognathic treatment

O objetivo deste estudo foi analisar, através de um relato de caso, a contribuição da técnica de fusão de imagem para o planejamento cirúrgico e a realização das goteiras prototipadas aplicadas à cirurgia ortognática. Paciente do gênero masculino, CML, 19 anos de idade, com Classe III esquelética e assimetria facial com subdesenvolvimento maxilar e deficiência vertical da maxila, teve o plano de tratamento estabelecido após moldagem intraoral. Os modelos foram enviados para a digitalização a laser 3D que contém duas câmeras e sistema de movimento tri-axial. A tomografia computadorizada cone beam CT, as imagens em 3D faciais e os modelos 3D digitais fundiram-se para fazer uma cirurgia virtual 3D, que simulou o tratamento proposto. A simulação cirúrgica 3D com fusão de imagem visa não somente aumentar a precisão da cirurgia em si e sua previsibilidade, mas também reduzir as complicações cirúrgicas.

The aim of this study was to examine, through a case report, the contribution of image fusion technique for the surgical planning and production of prototype trays applied to orthognathic surgery. A male patient, CML, 19 years old, with skeletal Class III and facial asymmetry by maxillary underdevelopment assisted by a vertical height of the maxilla. The treatment plan was established after intraoral molding. The models were sent to the digital scanning laser 3D that it contains 2 cameras and tri-axial movement system. The cone beam computed tomography, facial 3D images and digital 3D models were merged to make a virtual 3D surgery, which simulated the proposed treatment. The surgical simulation 3D with image fusion aims not only to increase the accuracy of the surgery itself and its predictability, but also to reduce surgical complications.

Alternative treatment for open bite Class III malocclusion in a child with Williams-Beuren syndrome.

Williams-Beuren syndrome (WBS) is a rare genetic condition that affects approximately 1 in every 20,000 - 50,000 live births. WBS children have specific skeletal deformities, dental malformations and rare lingual muscle dysfunction. The need for orthodontic and orthognathic therapy has arisen and has been considered a real clinical challenge even for experienced professionals, once it requires a complex and individualized treatment plan. This study reports a case of orthopedic expansion of the maxilla, in which a modified facial mask was used for protraction of the maxillary complex associated with clockwise rotation of the maxilla. In addition, special considerations about treatment time and orthopedic outcomes are discussed.

Alternative treatment for open bite Class III malocclusion in a child with Williams-Beuren syndrome

Williams-Beuren syndrome (WBS) is a rare genetic condition that affects approximately 1 in every 20,000 - 50,000 live births. WBS children have specific skeletal deformities, dental malformations and rare lingual muscle dysfunction. The need for orthodontic and orthognathic therapy has arisen and has been considered a real clinical challenge even for experienced professionals, once it requires a complex and individualized treatment plan. This study reports a case of orthopedic expansion of the maxilla, in which a modified facial mask was used for protraction of the maxillary complex associated with clockwise rotation of the maxilla. In addition, special considerations about treatment time and orthopedic outcomes are discussed.

A síndrome de Williams-Beuren (WBS) é uma doença genética rara, acometendo, aproximadamente, de 1:20.000 a 1:50.000 crianças nascidas. As crianças com WBS têm deformidades esqueléticas específicas, má formações dentárias e, algumas vezes, disfunção muscular da língua. As necessidades ortodônticas e ortognáticas têm sido consideradas um verdadeiro desafio clínico, até mesmo para aqueles profissionais com vasta experiência, uma vez que requerem um plano de tratamento individualizado e complexo. Esse relato de caso aborda uma expansão ortopédica da maxila, em que foi utilizada uma máscara facial modificada para protração do complexo maxilar, acompanhada de uma rotação horária da maxila. Além disso, considerações especiais sobre o tempo de tratamento e resultados ortopédicos são discutidas.

Odontogenic myxoma in children: case report

Odontogenic myxoma is a rare tumor, often diagnosed during routine radiographs or when it is so severe that it causes pain, a noticeable increase in volume or tooth displacement and mobility. Young adults (25-30 years of life) are more often affected by the lesion but all ages are vulnerable. The mandible is more commonly involved than the maxilla and the tumors usually grow slowly and silently. However, growth can be rapid and destructive. The radiographic aspect of a myxoma is that of a uni or multilocular, radiolucent lesion reminiscent of honeycomb or soap bubbles, depending on its size. It is an expansive tumor that may cause displacement or resorption of the teeth involved. Microscopically, the tumor is composed of round and spindle cells, with a star arrangement, arranged in a loose abundant myxoid stroma, containing only a few collagen fibrils. The treatment of choice is radical surgical excision because myxomas are not encapsulated and tend to infiltrate the surrounding bone. However, small tumors can be treated by curettage. Periodic reassessment is required for at least five years due to the high rate of recurrence. Larger tumors may need to be treated using a more extensive resection with a safety margin. This study reports a clinical case of odontogenic myxoma in a child aged 7 years. The tumor was located in the posterior region of the mandible and was surgically treated with an en bloc resection with preservation of the base of the mandible. The follow-up of the case is ongoing and no recurrence has been observed to date.

Cementoblastoma benigno na mandíbula: Relato de caso / Benign cementoblastoma in mandible: a case report

O cementoblastoma benigno (CB) é um tumor odontogênico raro, de crescimento lento e ilimitado. Ocorre mais frequentemente em caucasianos, entre as 2ª e 3ª décadas de vida, sem predileção por gênero. Mais comum na mandíbula, área de molares e pré-molares, geralmente envolve o primeiro molar permanente. Em imagem radiográfica, apresenta massa radiopaca delimitada por delgada linha radioluscente, simulando uma hipercementose. Em cortes histológicos, assemelha-se fortemente com osteoma osteoide, osteosarcoma ou osteoblastoma benigno. O objetivo do presente trabalho foi descrever um caso incomum de cementoblastoma. I.D.S., gênero masculino, melanoderma, 32 anos que compareceu ao ambulatório do Grupo de Apoio Aprendizes do Amor Cristão - GAAAC, Brasília - DF, sem queixa de dor, portando lesão na região do 2º molar mandibular esquerdo, apresentando imagem radiográfica sugestiva de cementoblastoma. O tratamento consistiu na remoção completa da lesão acompanhada de extração do dente 37. Após dois anos, observou-se a remissão dos sinais, não havendo recorrência do tumor. O caso relatado apresentou como variante incomum ter acometido indivíduo da raça negra, relacionado ao 2º molar mandibular esquerdo - 3%. O sítio de localização atípico e as discrepâncias encontradas entre o presente relato e a literatura reforçam a importância do diagnóstico e a pesquisa por novas evidências relacionadas ao cementoblastoma.

The cementoblastoma benign (CB) is a rare odontogenic tumor, slow growth and unlimited. It occurs more frequently in caucasians, between 2nd and 3rd decades of life, with no predilection for gender. More common in the mandible area of molars and premolars, usually involving the first permanent molar. In radiographic image shows a radiopaque mass bounded by thin radiolucent line simulating a hypercementosis. Using histological resembles strongly with osteoid osteoma, osteosarcoma and benign osteoblastoma. The aim of this study was to describe an unusual case of cementoblastoma. IDS, male, melanoderma, 32 years old, came to the Grupo de Apoio Aprendizes do Amor Cristão - GAAAC, Brasília - DF, without pain, with a lesion in the 2nd left molar region, presenting radiographic image suggestive of cementoblastoma. The treatment consisted of complete removal of the lesion accompanied by the extraction of the tooth 37. After two years, there was remission of signs, with no tumor recurrence. This case presents unusual variant as the fact that it involved an individual of black, related to 2nd left mandibular molar - 3%. The rarity of the condition and the discrepancies found between this case and the literature of reinforce even more the importance of any new evidence related to cementoblastoma.

Reação pulpar ao lipopolissacarídeo de Escherichia coli / The pulp reaction to Escherichia coli lipopolysaccharide

Introdução - A presença de bactérias e seus subprodutos na cavidade bucal representa risco freqüente ao tecido pulpar. Os lipopolissacarídeos (LPS) bacterianos figuram como importantes agentes deletérios do metabolismo celular. ganhando desta que nas infecções pulpo-periapicais. Presentes nas paredes das bactérias gram-negativas atuam com alto grau imunogênico. Material e Métodos - Inoculou-se 0,05 ml de LPS, na concentração de 150 mg/ml, em polpas de dentes de cães expostas cirurgicamente e restauradas com ionômero de vidro. As polpas foram avaliadas nos períodos de 1,7, 15, 30 e 60 dias. Resultados - Os resultados demonstraram que, nessa concentração, os LPS interferem no padrão de resposta do tecido pulpar. Conclusões - Essa interferência se mostrou negativa acelerando o processo de destruição tecidual, levando-o à necrose.

The reaction of dental pulp to Escherichia coli lipopolysaccharide and Enterococcus faecalis lipoteichoic acid

This research evaluates the effects of the lipopolysaccharides (LPS) from Escherichia coli and lipoteichoic acid (LTA) from Enterococcus faecalis on dental pulp. These molecules are components of the Gram-negative and Gram-positive bacteria cell wall, respectively. Ten dogs were used in the experiment. Inoculation in surgically opened pulp and coronal restoration with glass ionomer was the method chosen. The evaluation times were 1, 7, 15, 30 and 60 days. The results showed that the LPS and LTA, at 150 icg/ml, produced a negative interference in the pulp leading to destruction. LTA caused less damage than LPS.