C-Jun N-terminal kinase (JNK) pathway activation is essential for dental papilla cells polarization.

During tooth development, dental papilla cells differentiate into odontoblasts with polarized morphology and cell function. Our previous study indicated that the C-Jun N-terminal kinase (JNK) pathway regulates human dental papilla cell adhesion, migration, and formation of focal adhesion complexes. The aim of this study was to further examine the role of the JNK pathway in dental papilla cell polarity formation. Histological staining, qPCR, and Western Blot suggested the activation of JNK signaling in polarized mouse dental papilla tissue. After performing an in vitro tooth germ organ culture and cell culture, we found that JNK inhibitor SP600125 postponed tooth germ development and reduced the polarization, migration and differentiation of mouse dental papilla cells (mDPCs). Next, we screened up-regulated polarity-related genes during dental papilla development and mDPCs or A11 differentiation. We found that Prickle3, Golga2, Golga5, and RhoA were all up-regulated, which is consistent with JNK signaling activation. Further, constitutively active RhoA mutant (RhoA Q63L) partly rescued the inhibition of SP600125 on cell differentiation and polarity formation of mDPCs. To sum up, this study suggests that JNK signaling has a positive role in the formation of dental papilla cell polarization.

Papilla-Crown Height Dimensions around Zirconium Dioxide Implants in the Esthetic Area: A 3-Year Follow-Up Study.

PURPOSE: Soft tissue interactions with ceramic dental implants have previously been shown to have favorable esthetic outcomes. This study aimed to evaluate the papilla-crown proportion around zirconia implants in a 3-year follow-up study and the correlation between the gingival biotype and changes in papillary height. MATERIALS AND METHODS: This was a prospective study of 39 patients with 40 single-gap implants (Straumann PURE Ceramic ZLA Implant). The papilla-crown proportion was assessed after 3 months, 1 year, and 3 years. In addition, correlations between the peri-implant biotypes and changes in papillary heights were evaluated. RESULTS: The papilla-crown proportion improved from 35.5% after 3 months to 41.7% after 3 years. The gingival biotype was correlated very weakly to papilla height alterations. Significant papillary fill was observed in the interdental space between 3 months and 3 years (p < 0.001). CONCLUSIONS: An ideal papilla-crown proportion of 40% around single implants was observed after 3 years. A thin or thick gingival biotype showed a very weak correlation with soft tissue alterations.

Nonincised Papillae Surgical Approach (NIPSA) in Periodontal Regeneration: Preliminary Results of a Case Series.

A new surgical approach has been developed to optimize the preservation of the gingival margin and papillae when treating periodontal defects. The flap is raised by one mucosal incision far away from the marginal tissues. This case series reports on the effectiveness of a nonincised surgical approach (NIPSA) in conjunction with a hydroxyapatite-based graft biomaterial and enamel matrix derivative in treating intrabony defects. Ten defects in 10 patients were treated. The follow-up period ranged from 6 to 18 months (mean: 10.8 ± 4.7 months). Probing pocket depth was 9.6 ± 2.3 mm before surgery and 2.3 ± 0.5 mm postsurgery. Clinical attachment level (CAL) decreased from 10.4 ± 2.7 mm to 3.1 ± 0.87 mm postsurgery. The gingival papilla height, keratinized tissue width, and buccal gingival margin remained stable over time. No wound dehiscence was recorded. Mean Early Healing Index was 1.5 ± 0.7. Results show a substantial CAL gain, limited postsurgical shrinkage, minimal morbidity, and early healing.

Interproximal Papilla Stability Around CAD/CAM and Stock Abutments in Anterior Regions: A 2-Year Prospective Multicenter Cohort Study.

The aim of this study was to compare the interproximal papilla stability of restorations supported by computer-aided design/computer-assisted manufacture (CAD/CAM) abutments to those supported by prefabricated stock abutments in anterior areas over a 2-year follow-up. Abutments were selected depending on implant inclination and thickness of buccal peri-implant soft tissues from the following: zirconia stock, titanium stock, zirconia CAD/CAM and titanium CAD/CAM. Differences between the height of the papilla tip were measured (REC). RESULTS: REC values of titanium and zirconia CAD/CAM abutments were significantly lower than those of titanium and zirconia stock. The use of titanium and zirconia CAD/CAM abutments is related to better interproximal papillae stability.

Connective Tissue Graft Wall Technique and Enamel Matrix Derivative for the Treatment of Infrabony Defects: Case Reports.

The present case report describes a modification of the connective tissue graft wall technique with enamel matrix derivative applied to treat deep vertical bony defects. The technique presented uses a palatal incision to gain access to the bony defect. Deep infrabony defects affecting two maxillary central incisors associated with interdental and buccal gingival recession were treated. At 1 year after surgery, 9 and 6 mm of interdental clinical attachment level gain were seen in cases 1 and 2, respectively. The position of the interdental papilla was improved, and complete root coverage was achieved. Radiographs demonstrated bone fill of the infrabony components of the defects. This report encourages the possibility to improve, in one surgical session, regenerative and esthetic parameters in the treatment of deep infrabony defects.

Local Injection of Hyaluronic Acid Filler Improves Open Gingival Embrasure: Validation Through a Rat Model.

BACKGROUND: The open gingival embrasure, the so-called black triangle, is one of the unsolved dilemmas in adult dentistry. Although various techniques have been introduced to improve black triangles, the lack of reproducible experimental models has prevented development of successful protocols to regenerate or to compensate loss of the interdental papilla. Therefore, the objective of this study is first to develop a reliable animal model of open gingival embrasure and then to validate a minimally invasive injection technique using hyaluronic acid (HA) filler to augment the interdental papilla. METHODS: To reproduce open gingival embrasure in rats, rapid space opening was induced between the mandibular incisors by attachment of a compression spring. Loss of interdental papilla height was morphologically evaluated and calculated using standardized serial photographs, microcomputed tomography, and histologic sections. Afterward, HA fillers or phosphate-buffered saline (PBS) was locally injected, and changes in the interdental papilla were evaluated. RESULTS: After 7 days of space opening, the margin of the interdental papilla between the mandibular incisors gradually became irregular and flat, indicating a condition similar to the open gingival embrasure (P <0.05). Local injection of HA filler induced an augmentation effect of the interdental papilla compared with injection of PBS (P <0.05). Interdental papilla became convex, and inner granules containing HA were detected within the submucosal layer after its injection. CONCLUSIONS: Open gingival embrasure was reproduced reliably in vivo. Local injection of HA filler was validated as a meaningful minimally invasive procedure to improve open gingival embrasure.

Role of GATA binding protein 4 (GATA4) in the regulation of tooth development via GNAI3.

Transcription factor GATA4 regulates cardiac and osteoblast differentiation. However, its role in tooth development is not clear. Therefore, we generated Wnt1-Cre;GATA4 fl/fl mice, with conditional inactivation of the GATA4 gene in the dental papilla mesenchymal cells. Phenotypic analysis showed short root deformity along with reduced expressions of odonto/osteogenic markers. Proliferation (but not apoptosis) of cells around the apical area of the root was attenuated. In vitro, we knocked down GATA4 expression in stem cells of dental apical papilla (SCAPs). Proliferation, migration and odonto/osteogenic differentiation of SCAPs were affected in the shGATA4 group. Overexpression of GATA4 in SCAPs increased mineralization. Based on our previous iTRAQ results, guanine nucleotide binding proteins 3 (GNAI3) is one of the distinct proteins after GATA4 deletion. G protein signaling is involved in bone development, remodeling, and disease. In this study, both GATA4 deletion in the mouse root and knock-down in human SCAPs decreased the expression of GNAI3. Dual-luciferase and ChIP assay confirmed the direct binding of GATA4 to the GNAI3 promoter, both in vitro and in vivo. GNAI3 knock-down significantly decreased the odonto/osteogenic differentiation ability of SCAPs. We thus establish the role of GATA4 as a novel regulator of root development and elucidate its downstream molecular events.

Evaluation of Pink and White Esthetic Scores for Immediately Placed and Provisionally Restored Implants in the Anterior Maxilla.

PURPOSE: To evaluate the esthetic result of immediately placed implants with immediate provisional restorations in the anterior maxilla using the pink esthetic score (PES) and white esthetic score (WES). MATERIALS AND METHODS: The records of patients were evaluated retrospectively. The evaluation was carried out by two examiners using 12 evaluation criteria. RESULTS: The average PES value from the evaluation of 53 images obtained from the 53 selected patients (22 men and 31 women) was 8.63 ± 2.4 (range, 1-14), whereas the average WES value was 6.92 ± 1.67 (range, 2-10). The mesial papilla had the highest average PES (1.39 ± 0.4) and the distal papilla had the lowest PES (0.87 ± 0.54). Texture had the highest average WES (1.54 ± 0.34) and tooth shape had the lowest average WES (1.25 ± 0.43). CONCLUSION: Treatment with immediate implants providing immediate provisional restoration in the anterior maxilla yields good clinical esthetic outcomes, as assessed by PES/WES values. The PES and WES values showed strong intraexaminer agreement, but weak interexaminer agreement.

Survival of the Apical Papilla and Its Resident Stem Cells in a Case of Advanced Pulpal Necrosis and Apical Periodontitis.

INTRODUCTION: Apical papilla represents a source of an enriched mesenchymal stem cell (MSC) population (stem cells of the apical papilla [SCAPs]) that modulates root development and may participate in regenerative endodontic procedures in immature teeth with pulp necrosis. The characteristics and phenotype of this tissue in the presence of inflammation are largely unknown. The purpose of this study was to characterize a human apical papilla sample that was isolated from an immature tooth with pulp necrosis and apical periodontitis. METHODS: Inflamed periapical tissue that included part of the apical papilla (apical papilla clinical sample [CS]) was collected from an immature mandibular premolar previously diagnosed with pulp necrosis and apical periodontitis during an apexification procedure. Harvested cells from this tissue (SCAP CS) were compared with inflamed periapical progenitor cells (IPAPCs) and normal SCAP (SCAP-RP89) in flow cytometry and quantitative osteogenesis experiments. Part of the issue was further processed for immunohistochemistry and compared with apical papilla and coronal pulp sections from normal immature teeth as well as inflamed periapical tissues from mature teeth. RESULTS: Similar to SCAP-RP89, 96.6% of the SCAP CS coexpressed the MSC markers CD73, CD90, and CD105, whereas only 66.3% of IPAPCs coexpressed all markers. The SCAP CS showed a significantly greater mineralization potential than both SCAP-RP89 and IPAPCs. Finally, immunohistochemical analysis revealed moderate infiltration of cells expressing the inflammatory markers CD45/68 in the apical papilla CS and prominent CD24, CD105, and von Willebrand factor expression. CONCLUSIONS: Under inflammatory conditions, human apical papilla was found moderately inflamed with retained SCAP vitality and stemness and increased osteogenic and angiogenesis potential.

Regenerative Characteristics of Apical Papilla-derived Cells from Immature Teeth with Pulpal and Periapical Pathosis.

INTRODUCTION: The purpose of this study was to ascertain the regenerative characteristics of apical papilla-derived cells (APDCs) from immature teeth with pulpal and periapical pathosis and thus to provide proof-of-principle evidence for further regenerative endodontic research. METHODS: Pulpal and periapical pathosis was induced in immature permanent double-rooted premolars of beagles, which were randomly assigned to experimental treatment groups: group AO (n = 14), pulp disruption and access left open; group PS (n = 14), supragingival plaque suspension-soaked cotton pellet was introduced, and access was sealed; and control (n = 7), untreated. The teeth were extracted at 2- and 4-week periods after experimental treatments. APDCs were cultured from the extracted teeth, and their cellular proliferation, differentiation characteristics, and stemness were assessed. The data were statistically analyzed. RESULTS: After 4 weeks of intentional pulpal and periapical pathosis induction period, all teeth in group PS showed features of apical periodontitis with necrotic pulp, and their APDCs showed significantly increased proliferation rate and osteogenic/odontogenic differentiation capabilities (P < .05). The stemness was maintained in all APDCs, although the stem cell population was smaller in group PS at 2-week period when the inflammatory responses were most fulminant (P < .05). CONCLUSIONS: The APDCs from immature teeth retained the regenerative characteristics with the differences according to their pulpal and periapical pathosis. The results of this study partly provide the evidence for regenerative endodontic research.

Does the Papilla Preservation Flap Technique Induce Soft Tissue Modifications over Time in Endodontic Surgery Procedures?

INTRODUCTION: The aim of the present controlled clinical trial was to compare 2 incision techniques, papilla base incision (PBI) and sulcular incision (IS), evaluating changes in papilla and recession height over a 12-month period. METHODS: A total of 24 subjects requiring endodontic surgery on a single tooth were enrolled. PBI was used in 1 group and IS in the other group. The primary outcomes were changes in gingival recession of the tooth affected by periapical lesions and the mesial and distal teeth and the mesial and distal papilla height using the treated tooth as the reference. Outcome variables were assessed at baseline and 12 months after the surgical intervention. Statistical analysis was performed by a blinded operator through appropriate tests, with significance set at a P value equal to .05. RESULTS: In the PBI group, the papilla height at the 12-month follow-up in the mesial and distal aspect decreased 0.10 ± 0.32 mm and 0.10 ± 0.32 mm, respectively, and 0.23 ± 0.68 mm and 0.25 ± 0.40 mm, respectively, in the IS group without any significant differences. There were no differences found for recession change values between groups. CONCLUSIONS: The PBI and IS approaches in endodontic surgery showed similar results in terms of papilla height preservation and recession changes.

Interdental papilla loss: treatment by hyaluronic acid gel injection: a case series.

OBJECTIVES: The purpose of this prospective clinical trial was to examine the clinical and patient outcomes following esthetic reconstruction of interdental papilla loss in anterior teeth, using an injectable, non-animal-based, hyaluronic acid gel. MATERIALS AND METHODS: Ten systemically healthy adults, with at least one anterior site with class I or II interdental papilla loss, were recruited. Following local anesthesia, ∼0.2 ml of hyaluronic acid gel was injected directly into the base of the papilla. The injection was repeated twice 21 days later. Patients were seen monthly for follow-up. Lost papilla surface area was calculated from digital clinical photographs taken at baseline and at 4 and 6 months postoperatively. Differences in lost papilla surface area between baseline and postoperative time points were statistically analyzed. Participants completed questionnaires (satisfaction surveys). RESULTS: Seventeen sites (13 maxillary, 4 mandibular) were treated in 9 females who completed the study. The lost inderdental papilla area at baseline and at the 4- and 6-month postoperative visits was 1.2 ± 1.8 mm(2) (mean ± SD), 0.6 ± 0.9 mm(2), and 0.7 ± 0.7 mm(2), respectively. Differences between baseline and postoperative visits were statistically significant (p < 0.0001). Two thirds of the patients would choose to undergo the procedure again. CONCLUSIONS: Use of hyaluronic acid gel to treat interdental papilla loss resulted in significant improvement at 6 months. Patients expressed satisfaction with the obtained improvement and dissatisfaction with the associated procedure discomfort. CLINICAL RELEVANCE: Treatment of interdental papilla loss (black triangle) by hyaluronic acid gel injection appears a promising modality to address this esthetic patient concern.

Complication After Extraction of Natal Teeth with Continued Growth of a Dental Papilla.

The purposes of this case report were to describe a growing two-cm gingival mass that developed after natal teeth were extracted in a four-month-old female patient, present a review of the literature on the growth of a gingival mass after the extraction of natal teeth, and illustrate the clinical and histological features that differentiate this condition from other types of gingival masses in infants. Histological examination of the excised mass revealed that it contained tooth-like hard tissue (regular and irregular dentin) that intermingled with bone, dental pulp, and fibrous tissue. We found eight cases from 1962 to 2009 in which a soft-tissue mass with dentin-like hard tissue or a tooth-like structure had developed after the extraction of natal teeth. Based on clinical and histological findings, we deduced that the mass was the result of abnormal growth of a residual dental papilla, including mesenchymal stem cells. Consequently, dentists, obstetricians, gynecologists, and pediatricians should be aware of this potential complication and observe caution before they extract natal teeth.

A prospective cohort study on the impact of smoking on soft tissue alterations around single implants.

OBJECTIVES: To compare smokers to non-smokers in terms of soft tissue alterations following single implant treatment in healed bone. MATERIAL AND METHODS: Non-smoking and smoking patients with sufficient bone volume in need of a single implant in the anterior maxilla (15-25) were consecutively recruited in three centres. Conventional single implant surgery was performed and an immediate provisional crown was installed. Eight to 12 weeks later, the latter was replaced by a permanent one (baseline). Papilla regrowth and midfacial recession was registered after 2 years of function. RESULTS: The sample consisted of 39 non-smokers (21 females; mean age 42) and 46 smokers (22 females; mean age 45). Smokers had three early failures, whereas all implants integrated successfully in non-smokers. Statistically significant papilla regrowth was observed in non-smokers (distal 0.63 mm, mesial 0.76 mm), whereas smokers showed stable papillae (between cohorts: P ≤ 0.025). Midfacial soft tissue level demonstrated statistically significant regrowth in non-smokers (0.53 mm), whereas it remained stable in smokers (between cohorts: P = 0.004). CONCLUSION: Smokers failed to demonstrate papilla regeneration and showed more midfacial recession following single implant treatment when compared to non-smokers.

Expressão imuno-histoquimica de colagenase-1 e gelatinases A e B em mixomas odontogênicos e papilas de germes dentários / Immunohistochemical expression of collagenase-1 and gelatinase A and B in odontogenic myxomas and papillae of tooth germs

O mixoma odontogênico compartilha aspectos celulares e estruturais com a papila dentária, tendo-se implicado esta última como provável origem deste neoplasma. O propósito desta pesquisa consistiu em analisar comparativamente a expressão imuno-histoquímica de colagenase-1 (MMP-1) e gelatinases A (MMP-2) e B (MMP-9) em mixomas odontogênicos e papilas de germes dentários. Foram selecionados 12 casos de mixoma odontogênico e 08 espécimes de germes dentários, para análise da presença ou ausência de expressão imunohistoquímica e padrão de distribuição destas proteases em meio à matriz extracelular, bem como, o número de células positivamente marcadas para estas metaloproteinases de matriz (MMPs). Constatou-se diferença significativa (p<0,05) em relação à imunorreatividade para MMP-2, apresentando-se expressa apenas em meio à matriz extracelular dos mixomas. Para MMP-1 foi verificada imunorreatividade na maioria dos casos de mixomas, com proporções semelhantes às constatadas nas papilas dentárias. Em relação ao padrão de distribuição, evidenciou-se diferença significativa apenas para MMP-1 (p<0,05), com predominância do padrão focal nos neoplasmas. Por sua vez, a quantidade de células imunorreativas às proteases, nos mixomas odontogênicos, revelou diferenças significativas (p<0,05), estando a MMP-1 presente em maiores proporções, em comparação com as MMPs-2 e -9. Concluiu-se que a expressão de MMP-1, em nível comparável ao constatado nas papilas de germes dentários e numericamente superior às MMPs-2 e -9, sugere a implicação desta protease no processo de degradação da matriz extracelular nos mixomas odontogênicos e, em decorrência da possibilidade de associação das MMPs a receptores envolvidos no processo de adesão celular, especialmente às integrinas, ainda um provável papel na invasividade local destes neoplasmas. Adicionalmente, a evidenciação de um gradiente descendente na expressão imuno-histoquímica das MMPs nos mixomas odontogênicos, associada à especificidade de substrato inerente a cada uma destas proteases, sugerem a existência de um mecanismo coordenado entre colagenase intersticial e gelatinases A e B, direcionado à degradação eficiente da matriz extracelular e invasão local por parte das células neoplásicas. (AU)

The odontogenic myxoma shares cellular and structural aspects with dental papilla, which has been implicated as probable origin of this neoplasm. The aim of the present study was to perform a comparative immunohistochemical analysis for the expression of collagenase-1 (MMP-1) and gelatinases A (MMP-2) and B (MMP-9) in odontogenic myxomas and dental papilla of teeth germs. Twelve cases of odontogenic myxomas and eight specimens of teeth germs were selected. It was taken into consideration the presence or absence of immunoreactivity, the pattern of immunohistochemical distribution of proteases within extracellular matrix, as well as, the number of cells revealing immunostaining for matrix metalloproteinases (MMPs). It was verified a significant difference (p<0,05) in relation to MMP-2 immunoexpression, which was observed only within extracellular matrix of myxomas. Nevertheless, MMP-1 labeling was revealed by most of the cases of odontogenic myxoma, at levels close to those observed in dental papilla. In relation to the pattern of distribution, a significant difference was obtained between specimens (p<0,05), with neoplasms predominantly exhibiting a focal pattern for MMP-1. The quantitative analysis of neoplastic cells labeled for MMPs denoted a significant difference (p<0,05), demonstrating a higher proportion of MMP-1 in comparison to MMPs-2 and -9. It can be concluded that immunohistochemical expression of MMP-1 at levels comparable to those observed in dental papilla and quantitatively superior in relation to MMPs-2 and -9, suggest an implication of this protease on extracellular matrix degradation of odontogenic myxomas. Moreover, the possibility of interactions with receptors involved in cellular adhesion, particularly with integrins, suggests a plausible function on local invasiveness of such neoplasms. Additionally, the presence of a descent immunoexpression gradient for these MMPs on odontogenic myxomas, associated to substrate specificity inherent in each enzyme, suggest the existence of a coordinated mechanism between interstitial collagenase and gelatinases A and B in order to allow an efficient degradation of extracellular matrix and local invasion by neoplastic cells. (AU)

Congenital peripheral developing odontoma accompanied by congenital teratomatous fibroma in a 9-month-old boy: a case report.

Peripheral odontoma is rare, and only two cases of congenital peripheral odontoma have been reported. Congenital oral fibroma is also rare. We describe a unique case of congenital peripheral developing odontoma accompanied by congenital teratomatous fibroma in an infant. Both tumors were difficult to detect on radiography. Two small masses were seen in the median anterior portion of the palatal mucosa of a 9-month-old boy. The masses had been present since birth and were surgically removed at age 28 months, when one of the masses had grown to a diameter of 8 mm. Histopathologic examination showed a fibrous lesion and a tooth germ-like rounded lesion composed of dental papilla, enamel organ, dentin, and cementum. Although congenital odontoma is rare, it should be considered when selecting appropriate treatment, as early radiographic detection is difficult.

Excessive Wnt/ß-catenin signaling disturbs tooth-root formation.

BACKGROUND AND OBJECTIVE: Wingless-type MMTV integration site family (Wnt)/ß-catenin signaling plays an essential role in cellular differentiation and matrix formation during skeletal development. However, little is known about its role in tooth-root formation. In a previous study, we found excessive formation of dentin and cementum in mice with constitutive ß-catenin stabilization in the dental mesenchyme. In the present study we analyzed the molar roots of these mice to investigate the role of Wnt/ß-catenin signaling in root formation in more detail. MATERIAL AND METHODS: We generated OC-Cre:Catnb(+/lox(ex3)) mice by intercrossing Catnb(+/lox(ex3)) and OC-Cre mice, and we analyzed their mandibular molars using radiography, histomorphometry and immunohistochemistry. RESULTS: OC-Cre:Catnb(+/lox(ex3)) mice showed impaired root formation. At the beginning of root formation in mutant molars, dental papilla cells did not show normal differentiation into odontoblasts; rather, they were prematurely differentiated and had a disorganized arrangement. Interestingly, SMAD family member 4 was upregulated in premature odontoblasts. In 4-wk-old mutant mice, molar roots were about half the length of those in their wild-type littermates. In contrast to excessively formed dentin in crown, root dentin was thin and hypomineralized in mutant mice. Biglycan and dentin sialophosphoprotein were downregulated in root dentin of mutant mice, whereas dentin matrix protein 1 and Dickkopf-related protein 1 were upregulated. Additionally, ectonucleotide pyrophosphatase/phosphodiesterase 1 was significantly downregulated in the cementoblasts of mutant molars. Finally, in the cementum of mutant mice, bone sialoprotein was downregulated but Dickkopf-related protein 2 was upregulated. CONCLUSION: These results suggest that temporospatial regulation of Wnt/ß-catenin signaling plays an important role in cell differentiation and matrix formation during root and cementum formation.

Fibroma osificante periférico: revisión de la literatura y presentación de dos casos clínicos / Peripheral ossifying fibroma: review of the literature and report of two cases

El Fibroma Osificante Periférico (FOP) es una lesión reactiva que se localiza frecuentemente en las papilas interdentales, puede ser sésil o pediculada, indolora, del mismo color de la mucosa o rojiza, su tamaño varía de pocos milímetros a centímetros de diámetro, en ocasiones puede causar pérdida de los dientes adyacentes o resorción ósea. Se reportan dos casos de pacientes masculinos de 36 y 40 años de edad, quienes son referidos por sus odontólogos tratantes por lesiones en el Maxilar. En ambos casos se localiza en papila interdental del Incisivo Central y Lateral derecho (11 y 12), y se presentan como lesiones tumorales de aproximadamente 1 cm de diámetro, circunscritas, rojas, sangrantes y de superficie lisa y brillante

The Peripheral ossifying fibroma (POF) is a reactive lesion that is located in the interdental papilla often can be sessile or pedunculated, painless; the color of the mucosa or red, its size ranging from a few millimeters to centimeters in diameter, sometimes can cause loss of adjacent teeth or bone resorption. We report two cases of male patients 36 and 40 years of age who are referred by their dentists for injuries to his jaw. In both cases, interdental papilla located at 11 and 12 and are presented as mass lesions approximately 1 cm in diameter, circumscribed, red, bleeding and surface smooth and shiny

The effect of chronic alcohol intoxication and smoking on the output of salivary immunoglobulin A.

The effect of chronic alcohol intoxication and smoking on the output of salivary immunoglobulin A (IgA) was studied in 37 volunteers: 17 male smoking patients after chronic alcohol intoxication (AS) and 20 control non-smoking male social drinkers (CNS). The DMFT index (decayed, missing, or filled teeth), gingival index and papilla bleeding index (PBI) were assessed. Concentration of IgA in saliva was determined by ELISA. Salivary flow (SF) and IgA output were significantly decreased in AS compared to CNS. There were no significant correlations between the amount of alcohol/cigarettes as well as the duration of alcohol intoxication/smoking, and SF or IgA output, nor between IgA level and SF. Gingival index was significantly higher in AS than in CNS, and was inversely correlated with IgA salivary level. The worsened periodontal state in smoking alcohol-dependent persons may result from diminished IgA protection of the oral tissues due to its decreased output.