Evaluation of photodynamic therapy efficacy vs. conventional antifungal therapy in patients with poor-fitting dentures suffering from denture stomatitis. A prospective clinical study.

BACKGROUND: The long-term use of antifungal therapy in denture stomatitis (DS) treatment could be accompanied by antifungal-resistant strain onset, leading to compromised therapeutic procedure and disease reappearance. Photodynamic therapy (PDT) has shown the ability to eradicate oral infections and resistance strains. This prospective clinical study aimed to assess the PDT's effectiveness compared to the conventional treatment on clinical and microbiological parameters in patients with DS without denture wear during the treatment and follow-ups. METHODS: Forty-two patients diagnosed with DS were randomly assigned to one-session single PDT application (test group) or conventional antifungal therapy (control group). Clinical and microbiological parameters were assessed and analyzed before and at 3rd, 15th, and 30th day following the treatments. Microbiological samples were analyzed by a Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The data was statistically analyzed. RESULTS: Prior to the treatment, Candida species, including C. albicans (100%), C. glabrata (33%), C. tropicalis (31%), C. krusei (31%) were isolated in all patients. Both treatment procedures demonstrated a statistically significant reduction in C. albicans at all follow-up time intervals (p < 0.05). However, PDT displayed a statistically significant reduction in C. krusei compared to the conventional treatment at all follow-up periods (p < 0.05). Clinical parameters improved considerably in the test group compared to the control group at the 3rd and 15th day of follow-up. CONCLUSION: One-session single PDT application demonstrated significant improvement in both clinical and microbiological outcomes in a short-term period, resulting in complete Candida spp. eradication compared to conventional antifungal therapy.

Role of tumor suppressor protein p16 in patients with oral lichen planus.

PURPOSE: Oral lichen planus (OLP), is considered premalignant condition. This study tried to investigate the possibility of malignant transformation in OLP patients, by measuring the level of tumor suppressor protein p16INK4A, which is a product of the cyclin-dependent kinase inhibitor 2 (CDK2). CDK inhibitors may be responsible for maintenance of cell cycle. An imbalance in the cell cycle regulatory pathway involving p16/pRb may lead to unrestricted proliferation and tumorigenesis. METHODS: 40 patients with OLP underwent biopsy. Two control groups were included in this research, 13 healthy persons and 12 patients with oral squamous cell carcinoma (OSCC). All tissue samples were treated immunohistochemically using avidin-biotin peroxidase complex method. RESULTS: The number of patients with p16 positive cells was significantly higher in OLP (72.5%) in comparison to OSCC (33.33%). Although the prevalence of patients with p16 positive cells in OSCC was low, they expressed the highest percentage of p16 positive keratinocytes. Staining intensity of cytoplasm was also higher in p16 positive keratinocytes of OSCC in comparison to OLP. CONCLUSIONS: These results suggest that inactivation of p16 is an early detectable event in oral tumorigenesis. P16 expression could also be connected with tumor grading and may be useful marker in oral tumor progression.

Expression and role of p53 in oral lichen planus patients.

PURPOSE: Oral lichen planus (OLP) is an autoimmune skin and mucosal disorder. The range of malignant transformation in OLP varies between 0.1-3%. p53 is a tumor suppressor protein. Defective p53 could allow abnormal cells to proliferate, resulting in cancer. p53 plays an important role in cell cycle control and apoptosis and loss of p53 function has been demonstrated in about half of all human cancers. The purpose of the study was to investigate the malignant potential of OLP on the basis of p53 expression and to correlate p53 expression with clinical and histopathological features of OLP. METHODS: 40 patients with OLP underwent biopsy. All tissue samples were treated immunohistochemicaly using avidin-biotin peroxidase complex method. RESULTS: In 80% of OLP specimens the nuclei of basal and parabasal keratinocytes were p53-positive, but in low numbers. Low percentage of p53-positive cells in older and medium percentage of p53-positive cells in younger group of OLP patients were noted. Higher intensity of p53 stained keratinocytes, no matter their low number, could represent mutant and more stable form of p53 protein, and at the same time signal for monitoring of disease due to potential malignant transformation. Low percentage and weak intensity of p53-positive cells was detected mostly in OLP specimens with highly expressed civatte bodies (CB). Upregulation of apoptosis didn't correspond with the expression of CB. CONCLUSION: We believe that low percentage of p53-positive and well-marked keratinocytes in OLP represent the influence of mutant p53 protein, and that increasing expression of this protein could serve as a valuable diagnostic sign of early carcinogenesis. According to our results intensity of p53 coloration of keratinocytes could help assessing the malignant potential of OLP.

Changes in soft tissue profile following the treatment using a Herbst appliance--a photographic analysis.

BACKGROUND/AIM: Aesthetics is the reason for most of the class II malocclusion patients to opt for orthodontic treatment. In order to regulate retrognathic profile Herbst appliance for anterior movement of the mandible can be a treatment of choice. The aim of this study was to determine the soft tissue profile changes following Herbst appliance therapy on before and after treatment photos, using the computer program. METHODS: This investigation was performed on profile photographs of 20 class II patients (12 females and 8 males) aged 18-23 years. Analysis of the changes in soft tissue facial structure relationships evident on the photographs before and after the Herbst appliance therapy was performed using Bentley Micro Station program. The first contour of the soft tissue profile was marked. The following reference lines were subsequently traced: Ricketts aesthetic E line and Juanita line. The area enclosed by these two lines included the nose, upper and lower lip, chin and free space in front of the lips. Using the computer program, the surfaces of the soft tissue structures and free space defined by the reference lines and profile contours were measured. Calculation of the relative proportion of surfaces was done for each photograph. The data obtained were then compared for each patient before and after the treatment. Skeletal and dentoalveolar treatment effects that support soft tissue changes were presented by the profile cephalometric parameters of sagital occlusion (SO) analysis. RESULTS: A reduction in the relative surface of the upper lip in males (p < 0.01) and females (p < 0.05) was shown by the pictures. The space occupied by the chin was reduced after the treatment for females only (p < 0.05). The relative surface of the nasal soft tissues, that was included in the reference space was increased (p < 0.01) in both genders. The relationship between the soft tissue and empty surface was changed in favor of the empty surface (p < 0.05) in females. No statistically significant differences were found between the males and the females, before or after the Herbst appliance therapy. The soft tissue changes were the consequence of skeletal and dentoalveolar treatment effects: upper incisors retrusion, lower incisor protrusion and forward movement of the lower jaw. CONCLUSIONS: The Herbst appliance therapy caused a significant improvement of the profile appearance. The extent of soft tissue changes that occur on its dentoalveolar and skeletal support is a complex issue.