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Osseointegration is the major success factor for dental implants. In order to optimize the biological response, several strategies have been investigated. Due to its piezoelectric properties similar to bone electric potentials generated in loading function, barium titanate (BaTiO3) piezoelectric ceramic is a potential approach for promoting osteogenic proliferation and differentiation and, consequently, accelerating osseointegration. However, the potential inflammatory effects in peri-implant cells and tissues are not defined. The aim of this in vitro study was to evaluate the inflammatory response of gingival fibroblasts and human fetal osteoblasts in contact with BaTiO3-functionalized zirconia implant surfaces with piezoelectric properties. Composite discs with 5 wt.% BaTiO3 in Yttria-stabilized zirconia (YSZ) were prepared through press-and-sintering technique (n=15). Contact poling was carried out in silicon oil bath under DC 2 kV/mm electric field at 130 °C for 30 min followed with field cooling. Reference samples of YSZ were processed parallel to the composites. Human gingival fibroblasts (hTERT) and fetal osteoblasts (hFOB1.19) were cultured on discs for 14 and 7 days, respectively, by previously described methods. Cell viability was evaluated at 1, 3, 7 and 14 days using a commercial resazurin-based method. IL-1b and IL-6 were evaluated at 1 and 3 days in each fibroblast and osteoblast culture and osteopontin was measured in osteoblast cell culture at 3- and 7-days using ELISA. Osteoblasts alkaline phosphatase (ALP) activity was measured using an enzymatic colorimetric assay at 7 and 14 days. All results were presented as mean ± confidence interval (CI). Group comparisons were based on one-way ANOVA repeated measures or Kruskal-Wallis and Tukey’s post-hoc using appropriate statistical software and significance was set at p<0.05. Cell viability increased over time for all groups in both cell cultures. However, in osteoblasts was significantly lower in non-poled group at 14 days comparing to poled group. No significant differences in fibroblasts viability were observed between groups. Although a trend towards ALP activity significantly higher in poled group at 7 days (1.18±0.49 umol/min/mL) and YSZ group (2.22±0.17 umol/min/mL) at 14 days comparing to non-poled group (p<0.05), no significant differences in osteopontin secretion were observed between groups. Regarding osteoblasts inflammatory markers, IL-1b remains constant and a notorious increase from 1 to 3 days in IL-6 were observed in poled group, but without statistically significant differences between groups. Fibroblasts IL-1b secretion was similar to osteoblasts, with constant values over time and no significant differences between groups. However, IL-6 secretion decreased from 1 to 3 days in all study groups and repeated measures analysis revealed significant lower values in non-poled group (20.93±3.00 pg/mL) comparing to YSZ (43.79±13.77 pg/mL) at 3 days (p<0.05). Our results suggest that the Zirconia composite surfaces with the addition of BaTiO3 is not cytotoxic to peri-implant tissues cells. Additionally, samples with or without piezoelectric properties do not affect cellular differentiation and inflammatory profile. Nevertheless, the addition of non-poled BaTiO3 to YSZ may have a potential reduction effect in IL-6 mediated—inflammatory activity in fibroblasts.
Keywords: Dental implants, fibroblasts, osteoblasts, barium titanate, piezoelectric properties, cell culture
Introduction: Currently, Periodontitis is characterized by defining the stage and grade of the disease. Stage IV periodontitis has unique features that require treatment of a higher level of complexity. In this communication the sequence of periodontal treatment of a stage IV, generalized, grade C periodontitis is presented.
Clinical case description: A 30-year-old female patient attended at Periodontology Postgraduate Clinic in the Faculty of Dental Medicine, Lisbon, with complaints of tooth mobility and gingival bleeding. Smoker (≥ 1o cigarettes/day) without any other systemic diseases (ASA II). After the clinical and radiographic evaluation was diagnosed with a Stage IV, generalized, grade C Periodontitis. Following the interventions in Step 1 which included smoking cessation, explanation of the disease, professional oral hygiene instructions, patient started step 2 interventions – subgingival instrumentation (2 appointment of scaling and root planning). At periodontal re-evaluation, presented a plaque index of 15% and the presence of residual periodontal pockets. Step 3 included subgengival repeated instrumentation (2nd sextant), Resective/access periodontal surgery (3rd , 4th , 5th e 6th sextant) and Regenerative periodontal surgery (tooth 14 and 15).
Conclusion: The treatment has been successful in achieving a stable and healthy periodontium. Patient was placed in a supportive periodontal care programme (follow-up 8 months), with regular visits (3 in 3 months)
Keywords: Periodontitis, stage, grade, non-surgical treatment, surgical treatment
The increasing number of elderly population created a need of knowing better this population and giving them better quality of life by finding which are the gaps missing. One of the ways to study the oral health-related quality of life (OHRQoL) is applying the Geriatric Oral Health Assessment Index (GOHAI). This index is compound by three domains (physical, psychological and pain/discomfort).
The main objective of this study was to evaluate OHRQoL and the relationship between quality of life, sociodemographic characteristics and oral hygiene habits in the elderly of Egas Moniz Dental Clinic.
For seven months, an aleatory sample of 150 participants (n=150) of Egas Moniz Dental Clinic with 65 years or more of age and non-institutionalized were evaluated. It was applied a questionary about sociodemographic, oral hygiene and OHRQoL was obtained through GOHAI. A descriptive and inferential statistical analyze methodologies were used, and a significance level of 5% was considered.
In the studied population, 37.3% had a high classification of GOHAI. The male participants had tendency to have higher GOHAI self-perception (p=0.042), and especially in the physical domain (p=0.032). Participants who lived alone had lower global classification (p=0.025) and also in the pain/discomfort domain (p=0.025). Elderly who didn’t clean oral cavity had lower classification (p=0.033). The use of interdental cleaning aid (ICA) and not having the need of using an oral prosthesis showed higher GOHAI values.
The majority of the participants had a moderate and high self-perception of quality of life. Male, not living alone, who cleaned oral cavity, used ICA and did not have the need of use oral prothesis presented significantly better oral health-related quality of life. The gender and not living alone are aligned with previous researches. However, further research is needed.
Keywords: Elderly, GOHAI, geriatric population, oral health
Introduction: The concept of perineural inflammation in the mandible is old and well described in the literature, but it may be associated with bone morphological changes such as FDOJ (Fatty degenerative osteonecrosis in jawbone). FDOJ is a cavitational osteonecrosis, bone mineralization disorder, occurs in the medullary trabecular bone with aseptic, ischemic, sometimes asymptomatic nature, an immunologically altered chronic bone condition with expression of pro-inflammatory chemokines RANTES. Overexpression of this chemokine activates signaling pathways in the immune system, a fact that may contribute to neuralgias or atypical facial pain. Case report: This case study shows the need for a diagnosis of atypical pain associated with cavitational osteonecrosis and its surgical resolution. Female patient 31a, diagnosis of atypical facial pain, inconclusive neuralgia, without involvement of V cranial nerve. Shocking, limiting, radiating pain for 3 years.
Materials and methods: After analysis of bone density using CBCT images, the patient underwent cortical osteotomy and curettage of the altered alveolar bone in regions 18, 28, 38 and 48. The material removed was subjected to histopathological analysis to confirm the FDOJ.
Results: After surgically removing the cavitations in dental regions 18, 28, 38 and 48, the patient presented complete regression of the pain related to neuralgia. No new pain episodes at 1-year follow-up.
Discussion: RANTES/CCL5 inhibit opioid receptors (they play an important role in modulating pain in peripheral neurons and CNS), amplifying pain signals and increasing the pro-inflammatory response in microglia, generating neuroinflammation . In this context, it makes sense to reduce facial pain and trigeminal neuralgia by surgically cleaning the FDOJ in RANTES signaling areas. A significant limitation refers to the detection of this pathology. The lack of local inflammatory signs and radiographic image impairs the diagnosis of osteonecrosis. The lack of knowledge of the relationships of the chemokine RANTES by dentistry can be a challenge in solving these cases.
Conclusion: With the correct diagnosis of Cavitational Osteonecrosis and surgical FDOJ removal, it is possible to bring a consistent improvement in the patient's pain condition related to FDOJ. Bone density analysis of edentulous regions with tomography and transalveolar ultrasound can be a decisive diagnostic complement in the resolution of neuralgias and atypical facial pain.
Keywords: Osteonecrosis, Aseptic osteonecrosis, Bone cavitations, Cavitational osteonecrosis, FDOJ, NICO, BMDJ
Introduction: Chondrodysplasias are a heterogeneous group of genetic pathologies, characterized by changes in cartilage, which translate into abnormal skeletal development. Inside this group are the metaphyseal chondrodysplasias (MCDs), whose skeletal disorders mainly disturb the growth of long bones. Both the classification and diagnosis of these pathologies are based on clinical, radiological, and genetic aspects. In the MCDs, there is a group called type II collagenopathies, resulting from mutations in the gene that encodes the alpha-1 chain of type II collagen, the COL2A1 gene, culminating in an essential deficit for the endochondral ossification process. Therefore, these individuals suffer from disturbances in the epiphyseal plates, in the nucleus pulposus, and in the vitreous humor. Spondyloepimetaphyseal Dysplasia Strudwick type (SEMD) is a rare autosomal dominant entity. Clinically characterized by disproportionate short stature, pectus carinatum, scoliosis, lordosis, myopia, retinal detachment, equinovarus, genu valgum, coxa vara, hip arthritis, and even cleft palate, although there are cases described with normal craniofacial appearance. Radiographically, alterations such as metaphyseal dappling, atlantoaxial instability, hypoplasia of the odontoid process, platyspondyly and epiphyseal defects in the femur and tibia, among others, are detectable. Studies of MCDs at the orthodontic level are scarce and directed to specific subtypes, due to their low prevalence, and cases of orthodontic treatment (OT) in individuals with SEMD are absent in the literature.
Objective: This clinical case aims to demonstrate the importance of orthodontic diagnosis and correct planning of treatment timings in rare cases of craniofacial deformity. Case Report: A 14-year-old male patient with a history of SEMD and sleep apnea was referred for orthodontic treatment. Physical examination showed characteristic disproportionate short stature with genu valgum, coxa vara, pectus carinatum, and a face with mid-third hypoplasia, retrognathia, depression of the nasal bridge, and dental crowding. The main orthodontic problems observed were SEMD, skeletal and hyperdivergent class II, apical and buccal position of teeth 1.3 and 2.3, lack of maxillary and mandibular space, increased overjet and overbite, accentuated mandibular curve of Spee and deep bite. OT was planned with fixed multibracket appliances, transpalatal bar and extraction of the first premolars in the upper jaw. In the mandible, in addition to the multibrackets fixed appliance, stripping was performed.
Results: In the short term, correction of crowding, overjet, overbite and smile line was achieved, and canine class I, molar class II and canine guides were obtained. In the medium and long term, it was possible to prevent temporomandibular joint pathology, improve the occlusal relationship, chewing and the patient's facial aesthetics.
Conclusion: It is important that dentists, orthodontists and maxillofacial surgeons are conscious of this type of pathology in order to adapt OT to the severity of craniofacial anomalies, functional pathologies, and existing aesthetic alterations. In this way, it is possible to provide functional occlusion, improved facial appearance and quality of life in patients with MCD.
Keywords: Metaphyseal dysplasia, Collagen type II, Spondyloepimetaphyseal dysplasia, Strudwick type, Semd, Corrective Orthodontics
Leukoplakia is considered the most common potentially malignant lesion of the oral cavity, especially in adults over 40 years of age, and it has a multifactorial cause. Most of the time it is asymptomatic, which is why the Dentist must act with a global vision in routine consultations. Besides identifying and eliminating risk factors related to the appearance of the lesion, it is necessary to make a differential diagnosis by excluding other white lesions of the oral mucosa. A careful investigation of dysplasia in the histopathological study is essential to recognize the potential malignancy of the lesion and to promote an early diagnosis, which will strongly influence the prognosis, the treatment plan and the orientation of these patients. The present dissertation proposes to approach the potentially malignant oral leukoplakia lesion, providing the Dentist with updated and relevant information, supporting it with the presentation of a clinical case.
Keywords: Leukoplakia, Dysplasia, Histology, P16
