Periodontal changes induced by fixed orthodontic therapy.

Background: Orthodontic therapy is a complex process involving a series of specialists in the dental field: the oral-maxillo-facial surgeon, the periodontologist, sometimes even the prosthetist, implantologist, or general practitioners. The injuries of the oral mucosa induced by orthodontic therapy include gingival overgrowths, traumatic lesions of the oral mucosa, different degrees of periodontal damage manifested by gingival retraction, alveolar bone resorption. Methods: From a total of 327 subjects who came to the Dental Clinic in Craiova 74 subjects were selected, who presented with gingival overgrowth associated with fixed orthodontic therapy. Subjects' age ranged from 14 to 56 years and experienced bleeding and gingival discomfort as well as alterations in physiognomic function. None of the patients included in the study have systemic diseases and are not under medical treatment. The clinical and statistical study took place between May 2022 and December 2023. Each patient was given a personal record containing personal data as well as oral and systemic health status. The examination of the periodontal status aimed at the evaluation of the following indices: assessment of oral hygiene using the OHI-S index and the O'Leary plaque index, assessment of superficial periodontal status using the Löe/Silness gingival inflammation index, periodontometry was performed in order to determine the depth of periodontal pockets, the level of gingival insertion, and the McGaw gingival overgrowth index. OHI-S index comprises two elements: the Debris Index and the Calculus Index. The purpose of our study is to present the incidence of cases of gingival overgrowth induced by fixed orthodontic therapy and to highlight how certain irritating factors can exacerbate the symptoms of gingival overgrowth of orthodontic etiology. Results: The majority of patients were female, aged between 30 and 55 years. Most clinically examined patients have presented with Grade II gingival hyperplasia. Factors that have exacerbated the symptoms of orthodontically induced gingival overgrowth include: incorrectly adapted prosthetic restorations, unpolished massive coronal fillings, root remnants, bacterial plaque, and tartar. Clinical examination of the oral cavity revealed the presence of gingival inflammation (localized or generalized), simple or complicated, treated and untreated odontal lesions, and coronal fillings made of light-curing composite material of significant size, being unfinished and unpolished, sometimes with sharp edges directly injuring the adjacent gingival mucosa, marginally incorrectly adapted prosthetic works. In the case of child and adolescent patients, significant amounts of bacterial plaque and tartar buildup were observed. In most of the cases examined, it was observed that the gingival overgrowth had a firm consistency, pinkish-reddish colour and gingival bleeding was evident during probing. Conclusion: Gingival overgrowth caused by orthodontics induces a number of important periodontal changes. It is worth noting that gingival overgrowth induced by fixed orthodontic therapy, in most of the cases examined, co-exists with favouring factors that amplify its severity. In our study, the favouring factors were bacterial plaque and calculus accumulation, sharp-edged odontal lesions, marginally ill-fitting prosthetic restorations or massive unfinished crown fillings. Therefore, removing the contributing factors can help improve the symptoms but also to reverse the inflammatory phenomena.

Correlations between Immune Response and Etiopathogenic Factors of Medication-Related Osteonecrosis of the Jaw in Cancer Patients Treated with Zoledronic Acid.

Impairment of the immune response in MRONJ (medication-related osteonecrosis of the jaws) is one of the still unclear etiopathogenic mechanisms of this condition encountered in cancer patients treated with bisphosphonates, with negative effects on the patient's quality of life. The aim of the present study was to correlate the immune response with etiopathogenic factors via immunohistochemical evaluation of the maxillary tissues in zoledronic acid osteonecrosis. The retrospective study included a group of 51 patients with various types of cancers, diagnosed with stage 2 or 3 MRONJ at zoledronic acid and treated surgically. Immunohistochemical expressions of αSMA, CD3, CD4, CD8, CD20, CD79α, CD68, CD204, and tryptase were evaluated. Immunohistochemical markers expressions were statistically analyzed according to the duration of the treatment, the trigger factor, the location of the MRONJ, and the healing status. Analysis of the immune response included T lymphocytes, B lymphocytes, plasma cells, macrophages, and mast cells. The duration of treatment significantly influenced the immunohistochemical expression of most markers (p < 0.05). For an increasing trend in treatment duration, a decreasing trend in marker score was observed, suggesting an inverse correlation. The expression of the markers was different depending on the trigger factor, on MRONJ localization (maxilla/mandible), and the healing status, being more intense in patients cured per primam compared to those who had relapses. The patient's immune response was negatively influenced by the duration of the treatment, the trigger factor, the location of the lesion in the mandible, and the recurrence of MRONJ.

Risk Factors for Medication-Related Osteonecrosis of the Jaw-A Binomial Analysis of Data of Cancer Patients from Craiova and Constanta Treated with Zoledronic Acid.

MRONJ (Medication-Related Osteonecrosis of the Jaw) is a condition observed in a subset of cancer patients who have undergone treatment with zoledronic acid in order to either prevent or treat bone metastases. The primary aim of this research was to establish the importance of risk factors in the development of medication-related osteonecrosis of the jaw in cancer patients receiving zoledronic acid therapy for bone metastases. The present study is an observational retrospective investigation conducted at two university centers, namely, Craiova and Constanța, and included cancer patients treated with zoledronic acid. The medical records of the patients were obtained over a four-year timeframe spanning from June 2018 to June 2022. The data analysis was carried out between January 2021 and October 2022. Patients were treated for cancer, bone metastases, and MRONJ according to the international guidelines. The research investigated a cohort of 174 cancer patients (109 females and 65 males) aged between 22 and 84 years (with a mean age 64.65 ± 10.72 years) seeking treatment at oncology clinics situated in Craiova and Constanța. The study conducted a binomial logistic regression to analyze ten predictor variables, namely, gender, age, smoking status, treatment duration, chemotherapy, radiotherapy, endocrine therapy, presence of diabetes mellitus (DM), obesity, and hypertension (HT). The results of the analysis revealed that only five of the ten predictor variables were statistically significant for MRONJ occurrence: duration of treatment (p < 0.005), chemotherapy (p = 0.007), and hypertension (p = 0.002) as risk factors, and endocrine therapy (p = 0.001) and obesity (p = 0.024) as protective factors.

Clinical and Histopathological Aspects of MRONJ in Cancer Patients.

Medication-related osteonecrosis of the jaw (MRONJ) is a major complication of bisphosphonate treatment in cancer patients, and its etiology is not completely clarified. The study's goal is to find connections between the clinical and histopathological characteristics of osteonecrosis and bisphosphonates in a cohort of cancer patients who had osteonecrosis treated surgically. The retrospective study includes 51 patients of both sexes, aged 46 to 85 years, who underwent surgical treatment for MRONJ in two oral and maxillofacial surgery clinics (Craiova and Constanța). Demographic, clinical, and imaging data from the records of patients with osteonecrosis were analyzed. The surgical treatment removed the necrotic bone, and the harvested fragments were analyzed from a histopathological perspective. The histopathological examination data were evaluated and statistically processed to look for viable bone, granulation tissue, bacterial colonies, and inflammatory infiltrate. In the study groups, MRONJ was found particularly in the posterior regions of the mandible. Tooth extraction, but also periapical or periodontal infections, represented the trigger factors in most of the cases. The surgical therapy consisted of sequestrectomy or bone resection, and the histopathological examination of the fragments revealed osteonecrosis-specific features, such as the lack of bone cells, the development of an inflammatory infiltrate, and the existence of bacterial colonies. MRONJ in cancer patients receiving zoledronic acid is a severe complication that significantly lowers quality of life. Since these patients are not usually monitored by the dentist, they are identified in advanced stages of MRONJ. For these patients, thorough dental monitoring could reduce the incidence of osteonecrosis and its related complications.

Post COVID-19 Infection Psychosis: Could SARS-CoV-2 Virus Infection Be a Neuropsychiatric Condition That Triggers Psychotic Disorders? - A Case-Based Short Review.

Corona virus (COVID-19) is an epidemy of respiratory disease caused by a novel corona virus and it was declared by the World Health Organization (WHO) to be a global health pandemic emergency. Due to the neuropsychiatric manifestation of Covid-19 that have been associated with psychotic disorders, in this paper we choose to present a case from "Elena Doamna" Psychiatric Hospital from Galati, Romania and to correlate it with other cases from literature in a mini review presentation. In our paper, we present the case of a patient of 44-year-old men, with no past psychiatric history whose behavior included psycho-motor agitation, perception and thinking disorders, disorganized behaviour, attempted suicide by stabbing. The last perspectives from the two years of pandemic together with psychiatric disease linked the virus infections with psychosis to the main concern that Covid-19 could determine psychiatric disorders. There were also presented same literature studies of patients with no personal pathological history in the psychiatric field which developed psychiatric disorders after COVID-19 infection. SARS-CoV-2 has a psychological impact on the mental health status of the worldwide and, especially when it is associated with psychotic symptoms and can affect the quality-of-life. In some cases, the virus affected the brain and as a result, the psychosis symptoms could be an emerging phenomenon associated with the corona virus. Based on the DSM V and ICD-10 criteria, the diagnosis was of acute psychiatric disorders with symptoms of schizophrenia (F23.1). The case report and review reliefs that there is a causal link between the SARS CoV-2 infection and mental disorders, which is currently being investigated.

Adenoid Cystic Carcinoma of Salivary Gland: A Ten-Year Single Institute Experience.

Adenoid cystic carcinoma is a rare tumor, accounting for about 7.5% of all salivary gland neoplasms. More frequent developing in minor salivary gland, this is a slow-growing tumor with a long-lasting natural evolution, quite aggressive locally, but which has a tendency toward local recurrence and even for distant metastasis. We conducted a retrospective study limited to a period of 10 years in a single medical institution to investigate the morphoclinical profile of this tumor. Thus, we have established that about 60% of the tumors developed in men, with near 40% of the cases in patients in the sixth decade and, most common, the pathology affected the parotid and minor salivary glands from the hard palate mucosa. Histopathologically, prevailed the solid variant, with 72% cases presenting perineural invasion, and 41% cases showing positive surgical resection margins. Most cases had a long-standing asymptomatic evolution, so that at the time of diagnosis, more than two thirds of the patients were at least in stage II-pTNM, and in one-fifth of the cases histopathology showed lymph nodes disseminations.

Maxillary calcifying epithelial odontogenic tumor with sinus and buccal vestibule extension: a case report and immunohistochemical study.

BACKGROUND: Calcifying epithelial odontogenic tumor (CEOT) is a rare benign neoplasia, locally aggressive, that tends to invade bone and adjacent soft tissues. This case report describes the thirteenth known case of CEOT with maxillary sinus extension and the second one that also involves the buccal vestibule mucosa with peculiar histopathological and immunohistochemical data. CASE PRESENTATION: Here we report the case of a 45-year-old female with a CEOT diagnosed and treated at the Oral & Maxillofacial Surgery Department, County Clinical Emergency Hospital of Craiova, Romania. The clinical and imaging investigation revealed an intraosseous tumor developed from the left posterior maxilla with maxillary sinus and buccal vestibule mucosa extension. Histopathology found an epithelium-rich CEOT variant, but with scattered S100 positive clear cells, focal small rounded cementum-like deposits and areas with some degree of nuclear pleomorphism. The immunohistochemical investigations emphasised its local aggressiveness behavior with involvement of multiple molecular mechanisms that underlie tumor invasiveness. A subtotal maxillectomy was performed followed by defect reconstruction. CONCLUSIONS: We discuss the relevant clinicopathological features of an aggressive rare case of CEOT with maxillary sinus extension and buccal vestibule mucosa involvement. The immunohistochemical study suggests its utility in attempting to assess the degree of local tumor aggressiveness and thus in adopting the most efficient therapeutic attitude.

Role of transforming growth factor ß-connective tissue growth factor pathway in dihydropyridine calcium channel blockers-induced gingival overgrowth.

BACKGROUND: Gingival overgrowth was reported as a side effect after chronic administration of several drugs, which, despite their different pharmacological effect, seem to have the gingival mucosa as a secondary target. The thickness of the gingival epithelium and fibrosis in the lamina propria are unspecific changes that together determine the enlargement of the gingival mucosa, but the molecular mechanisms responsible for the imbalance of collagen synthesis/breakdown are still uncertain. The aim of our study was to assess the role of TGF-ß1-CTGF pathway in the activation of cells with a fibrilogenetic phenotype responsible for the gingival fibrosis developed after chronic administration of dihydropyridine calcium channel blockers. MATERIALS AND METHODS: Fragments of gingival tissue collected from patients clinically diagnosed with gingival overgrowth after chronic administration of nifedipine and amlodipine were processed for paraffin embedding. Serial sections were used for routine staining Masson and Gömöri's silver impregnation in order to reveal collagen accumulation and for immunohistochemical reactions to label TGF-ß1, CTGF, Ki67 and α-SMA. RESULTS: Routine histological staining for collagen revealed the presence of gingival fibrosis and a change between type I collagen/type III collagen ratio. Regardless of the drug involved, many slides showed extended TGF-ß1 positive areas, mainly in the profound - spinous and basal - layers, but also in some cells from the subjacent connective tissue. CTGF exposed intense positive reaction in the basal and parabasal layers, but also in resident cells from the connective tissue. Ki67 immunolabeling did not reveal an increased fibroblast proliferation in the lamina propria. We noticed the presence of a small number of myofibroblasts in the lamina propria. CONCLUSIONS: These findings suggest that TGF-ß1-CTGF axis is activated in dihydropyridine calcium channel blockers-induced gingival overgrowth and exerts a different control on the activation of fibroblasts with a synthetic phenotype. These results also have implications for better understanding mechanisms of fibrosis and the future use of this pathogenic pathway as a therapeutic target in order to limit gingival fibrosis.

Warthin tumor--morphological study of the stromal compartment.

Warthin tumor is the second most common benign tumors of the parotid gland, after pleomorphic adenoma. Our study was performed on 21 cases with Warthin tumor diagnosed between 2005-2010, which were analyzed clinically, histologically and immunohistochemically, using anti-CD20 and anti-CD45RO antibodies. The analysis of age distribution within the investigated cases indicated that Warthin tumor incidence is increasing in the seventh decade of life, most patients being male (M/F 5/2). Histopathological, the analysis report of stroma÷parenchyma in 14 cases revealed a balanced distribution of the two components, in four cases, the epithelial component was predominant and in three cases, the stromal component was predominant. Immunohistochemical study for the two specific lymphocyte proliferation markers indicated positivity for both epithelial component and stroma. Cell layout of CD45RO and CD20cy at the level of lymphoid stroma had a similar pattern with normal or reactive lymph nodes.