Retrospective Follow-up Assessment of Risk Variables Influencing the Outcome of Autologous Tooth Transplantation.

INTRODUCTION: This retrospective study aimed to identify which patient-, donor tooth-, recipient site-, and surgical procedure-related variables may influence the outcome of tooth autotransplantation. METHODS: The sample included 128 autotransplants performed in 122 patients. Single-visit clinical/imaging examinations were used to define the outcome as successful, survival, or failure. The association of potential indicators with the survival or failure categories was analyzed individually and adjusted for confounders through multivariate logistic regression models. RESULTS: After a follow-up period of 1 to 30.11 years, success was achieved in 71.8% of autotransplants, whereas the survival and failure groups had rates of 14.1% each, and the grouped success/survival rate reached 85.9%. An extraoral time >15 minutes and difficult handling/placement were strong/independent risk covariates for survival and failure categories (odds ratio >1, P < .05). Additionally, unerupted/partially erupted status of the donor tooth was a significant indicator for survival, whereas deficient bone level at the recipient site, surgical extraction, poor initial stability, and lack of prophylactic antibiotics were independently linked to failure (odds ratio > 1, P < .05). The root morphology and socket status acted as modifiers of the effect of the recipient site location on the survival group (P > .05). CONCLUSION: Based on the results of this study, unerupted/partially erupted status of the donor tooth, surgical extraction, total extraoral time >15 minutes, deficient recipient's bone level, difficult handling/placement of the autotransplant, poor initial stability, and lack of prophylactic antibiotics during the surgical procedure must be considered with caution when performing autotransplantation because of their deleterious influence on the outcome.

Relationship of the XRCC1 rs25487 polymorphism with demographic, behavioral, clinical, and histological parameters in oral potentially malignant disorders and oral squamous cell carcinoma in a Colombian population.

OBJECTIVES: To evaluate the salivary detection of XRCC1 rs25487 single-nucleotide polymorphism (SNP), its relationship with clinicopathological characteristics, and the interactions with demographic/behavioral variables in the etiopathogenesis of oral potentially malignant disorders (OPMD) and oral squamous cell carcinoma (OSCC) in a Colombian population. METHODS: Demographic/behavioral data and saliva samples were obtained from patients with oral leukoplakia (OL, n = 17) and oral lichenoid lesions with epithelial dysplasia (OLL-ED, n = 10), or OSCC (n = 45), along with healthy controls (n = 40). Tissue biopsies were obtained for histological assessment and genetic analysis was performed using polymerase chain reaction-restriction fragment length polymorphism. Descriptive analyses were used to compare the distribution of genotypes/alleles between study groups alongside an analysis of the interaction between genetic findings and demographic/behavioral variables. RESULTS: No association was observed between the genotype and allele frequencies in OPMD or OSCC. The AG genotype was significantly more frequent in OL with high-grade dysplasia, acanthotic epithelial lining, moderate-to-severe mitotic count, and negative-to-mild apoptotic count; and in OSCC cases with stage III/IV, poorly differentiated, perineural/lymphovascular invasion, severe cellular atypia, moderate-to-severe mitotic count, and negative-to-mild apoptotic counts. Significant interaction effects were detected in the AG genotype with regard to ageing, smoking habits, and alcohol consumption in both OL and OSCC. CONCLUSION: Although rs25487 SNP appeared to not modulate the risk of OPMD/OSCC independently, its significant association with clinicopathological characteristics in OL and OSCC, and the synergistic interaction between ageing and smoking/alcohol consumption, might play a role in these two diseases.

Cone-beam Computed Tomographic and Micro-computed Tomographic Evaluations of the Root Apexes of Teeth with Posttreatment Apical Periodontitis.

INTRODUCTION: This study evaluated the association of different variables that may influence the outcome of root canal treatment through cone-beam computed tomographic (CBCT) and micro-computed tomography (micro-CT) assessments of root apexes obtained by endodontic microsurgery of teeth with posttreatment apical periodontitis (AP), the agreement between CBCT and micro-CT findings, and the association of these variables with symptoms or lesion size. METHODS: Clinical and CBCT records and root apexes obtained by endodontic microsurgery from 11 cases of symptomatic AP and 22 cases of asymptomatic AP were available. Apical root specimens were further scanned using micro-CT imaging. CBCT parameters included periapical radiolucency size, apical extent/density of root canal filling, and occurrence of procedural errors. Micro-CT images evaluated the same parameters plus the presence of filling material in lateral canals and ramifications, the volume of the filled/nonfilled apical root canal, and the percentage of the nonfilled canal space. The agreement between CBCT/micro-CT observations was evaluated. RESULTS: Mandibular teeth, a lesion size <5 mm, a nonfilled volume <0.04 mm3, and the decreased percentage of the nonfilled canal volume were significantly associated with symptomatic AP. Maxillary teeth and inadequate apical filling density were significantly associated with larger lesions. Agreement between CBCT/micro-CT scores varied from fair (procedural errors) to satisfactory (extent/density of filling). CONCLUSIONS: Tooth location, lesion size, the nonfilled apical canal volume, and the percentage of the nonfilled apical canal volume were associated with symptomatic AP. In addition, lesion size was significantly associated with tooth location and apical root canal filling density. CBCT imaging may not provide a reliable evaluation of procedural errors associated with posttreatment disease.

Salivary Levels of NLRP3 Inflammasome-Related Proteins as Potential Biomarkers of Periodontal Clinical Status.

BACKGROUND: Emerging evidence suggests that activation of inflammasomes plays a central mechanism in pathogenesis of periodontitis. This study aims to compare salivary levels of nod-like receptor family pyrin domain containing protein (NLRP) 3, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), cysteine aspartase (caspase)-1, and interleukin (IL)-1ß from individuals with aggressive (AgP) or chronic periodontitis (CP) and healthy controls (HC), as well as elucidate its association with periodontal clinical status. METHODS: Saliva samples from individuals with CP (n = 75), AgP (n = 20), and HC (n = 69) were collected. Periodontal status was assessed by measurement of probing depth, clinical attachment level, and extent and severity of disease. Salivary levels of analytes were analyzed by enzyme-linked immunosorbent assay. Association between biomarkers with CP or AgP was analyzed using multivariate binary logistic regression models. RESULTS: Significantly higher levels of NLRP3, ASC, and IL-1ß were detected in periodontitis groups in comparison to the periodontally HC group. However, no significant differences were observed for caspase-1 levels between clinical groups, and only NLRP3 salivary concentration was significantly higher in AgP compared with CP patients. Also, positive significant correlations among NLRP3, ASC, and IL-1ß salivary concentrations and clinical parameters were observed. Logistic regression analyses revealed a strong/independent association of NLRP3, ASC, and IL-1ß salivary levels with CP and AgP. CONCLUSION: Although the concentration of caspase-1 in saliva samples makes its determination useless for detection of periodontal disease and/or its severity, salivary levels of NLRP3, ASC, and IL-1ß may act as strong/independent indicators of amount and extent of periodontal breakdown in both CP and AgP and could potentially be used for prevention and therapy of this group of diseases.

Determination of NLRP3 (rs4612666) and IL-1B (rs1143634) genetic polymorphisms in periodontally diseased and healthy subjects.

OBJECTIVE: The focus of the current study was to identify if a possible association between NLRP3 (rs4612666) and IL-1B (rs1143634) single-nucleotide polymorphisms (SNPs) may be implicated in the etiopathogenesis of chronic periodontitis (CP) in a Colombian population. DESIGN: One hundred and twenty-four CP subjects and 81 periodontally healthy controls (HC) were recruited. Periodontal status was assessed by criteria based on probing depth, clinical attachment level, extent, and severity of periodontal breakdown. Human genomic DNA was obtained from saliva samples of the study subjects. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to identify the NLRP3 (rs4612666) and IL-1B (rs1143634) SNPs. The association of polymorphisms with CP was assessed individually and adjusted for confounding using a multivariate binary logistic regression model. RESULTS: Bivariate analysis showed a weak association between CT genotype of NLRP3 (rs4612666) SNP and CP, however after logistic regression analysis, neither NLRP3 (rs4612666) nor IL-1B (rs1143634) polymorphisms were strongly/independently associated with disease status. Even so, an interaction effect was significantly detected not only among CT/CC genotypes of NLRP3 gene regarding to the age stratum ≥ 48 years, but also between CC genotype of the same gene and smoking habit. CONCLUSION: Although the present results do not support that IL-1B (rs1143634) SNP could be identified as a risk predictor for CP in the present population, the synergistic interaction of the CT/CC genotypes of NLRP3 (rs4612666) SNP with ageing and/or smoking habit potentially might play a significant role in the pathogenic pathways of periodontal disease.

Prognostic Value of 8-Hydroxy-2'-Deoxyguanosine and Human Neutrophil Elastase/α1-Proteinase Inhibitor Complex as Salivary Biomarkers of Oxidative Stress in Chronic Periodontitis.

BACKGROUND: 8-Hydroxy-2'-deoxyguanosine (8-OHdG) and human neutrophil elastase/α1-proteinase inhibitor (HNE/α1-PI) complex have been regarded as reliable biomarkers of oxidative stress in inflammatory conditions. This study investigates whether the salivary levels of these two analytes may be linked with periodontal health status. METHODS: One hundred ten patients with chronic periodontitis (CP) and 50 healthy controls were selected. Periodontal status was assessed by criteria based on probing depth, clinical attachment level, and extent and severity of periodontal breakdown. 8-OHdG and HNE/α1-PI salivary levels were analyzed by enzyme-linked immunosorbent assay. The association of these analytes with CP was analyzed individually and adjusted for confounding factors using a multivariate binary logistic regression model. RESULTS: Significantly higher levels of both markers were detected in the CP group in comparison to controls. Weak-to-moderate positive significant correlations between salivary biomarkers and clinical parameters were observed. After binary logistic regression analysis, salivary levels of 8-OHdG >17.35 ng/mL and HNE/α1-PI complex >158.28 ng/mL were independently associated with disease status. Interaction effects among candidate prognostic variables were also noted. CONCLUSIONS: Increased salivary levels of 8-OHdG and HNE/α1-PI complex may be strong, independent prognostic indicators of the amount and extent of oxidative stress-induced periodontal breakdown. In addition, unstimulated whole saliva samples might reflect a synergistic biologic interactive effect of HNE/α1-PI associated with the aging and smoking cumulative characteristics of periodontal damage.

Association study between clinicopathological variables and periodontal breakdown in gingival pyogenic granuloma.

OBJECTIVE: The aim was to investigate a possible association between the immunoexpression of interleukin (IL)-4 and clinicopathological parameters with the periodontal breakdown observed in gingival pyogenic granuloma (PG). MATERIALS AND METHODS: Paraffin-embedded samples of gingival PG (n = 46) were prepared for histological and immunohistochemical assessment. Demographic and clinical parameters were assessed by criteria based on age stratum, gender, smoking habit, evolution course, location, lesion size, macroscopic appearance, predisposing factors, recurrence, and periodontal breakdown. Histological assessment included the appearance of epithelial lining, microvessel density, inflammatory infiltrate density, interstitial fibrosis, and histological arrangement. A staining intensity distribution (SID) score was used to assess IL-4 immunoreactivity. The association between candidate predictor variables and periodontal breakdown was analyzed individually and adjusted for confounding using a bivariate binary logistic regression model. RESULTS: Mean IL-4 SID values were significantly increased for long-standing and large lesions, presence of periodontal breakdown, high microvessel density, and moderate-to-severe inflammatory infiltrate density. While bivariate and univariate analyses revealed a positive association of the evolution course ≥12 months, lesion size >1 cm, high microvessel density, moderate-to-severe inflammatory infiltrate density, and IL-4 SID score ≥8.04 with periodontal breakdown, after bivariate logistic regression analysis, only the evolution course ≥12 months, moderate-to-severe inflammatory infiltrate density, and IL-4 SID score ≥8.04 remained as robust predictors of periodontal damage. Confounding and interaction effects between candidate predictor variables were also noted. CONCLUSION: These findings suggest that while evolution course, inflammatory infiltrate density, and the overexpression of IL-4 may act as predictors of periodontal breakdown in gingival PG, there are mutual confounding and synergistic biological interactive effects with respect to the lesion size and microvessel density in the susceptible host that may be also associated with the bone resorption and tissue destruction. CLINICAL RELEVANCE: Although the first-line therapy of gingival PG continues to be the surgical excision, this approach poses unwanted complications such as severe mucogingival defects and recurrence. Hence, early diagnosis and detection of these three significant predictor variables as well as timely surgical excision might help prevent the periodontal tissue destruction observed in some of these lesions.

Comparison of the effect of two sugar-substituted chewing gums on different caries- and gingivitis-related variables: a double-blind, randomized, controlled clinical trial.

OBJECTIVE: The aim of this study was to compare the effect of two sugar-substituted chewing gums besides toothbrushing on different clinical, microbiological, and biochemical caries- and gingivitis-related variables. MATERIALS AND METHODS: The study was designed as a double-blind, randomized, controlled trial with three parallel arms. A total of 130 dental students, who volunteered after signing an informed consent, were randomly allocated to receive one of the following interventions: hexitol-sweetened gum containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), pentitol-sweetened gum containing no CPP-ACP, and control group with no gum. Subjects within the experimental groups chewed two gum pellets for 20 min three times a day after meals. The daily consumption level of both polyols was 6.0 g. Clinical examinations and salivary samplings were conducted at baseline and after 30 days of gum use. Pre- and post-intervention stimulated whole saliva samples were quantified for calcium/phosphate ionic concentration, total facultative bacterial load, Streptococcus mutans/Lactobacillus spp. counts, and Gram-negative percentage. RESULTS: A statistically significant reduction in visible plaque score was displayed in the hexitol/CPP-ACP gum group after the intervention when compared with baseline, but the order of the effect was in the same order as the differences between the groups at baseline. A similar tendency was seen in both the pentitol/non-CPP-ACP gum and control groups regarding total salivary facultative bacterial load and S. mutans count, but median values of these parameters were more significantly reduced in the pentitol/non-CPP-ACP gum group in comparison with those of the control group. Alterations of salivary Lactobacillus spp. were demonstrated only in the pentitol/non-CPP-ACP gum group. CONCLUSION: Although these findings might indicate that a 30-day protocol of daily chewing of pentitol-sweetened gum containing no CPP-ACP might have some a reducing effect on the salivary levels of facultative bacteria, S. mutans and Lactobacillus spp., there was only a marginal, if any, benefit from the chewing gums under study on some microbiological caries- and gingivitis-related variables. CLINICAL RELEVANCE: Taking into account that for transferring results into clinically relevant conclusions the findings need to be strong and consistent, adhering to single significant differences appears not appropriate. Hence, the clinical significance of chewing gums as an adjunctive tool for daily oral care remained questionable.

Screening for salivary levels of deoxypyridinoline and bone-specific alkaline phosphatase during orthodontic tooth movement: a pilot study.

Deoxypyridinoline (DPD) and bone-specific alkaline phosphatase (BAP) have been regarded as systemic determinants of bone remodelling. Owing this fact, this study aimed to determine whether the variations in the salivary concentration of these two biomarkers as detected through a longitudinal follow-up with four consecutive visits may be linked with the different phases of orthodontic tooth movement (OTM). Twenty-two healthy subjects who required fixed appliance therapy not involving tooth extractions/surgical procedures were selected. Unstimulated whole saliva samples were collected from each patient prior to fitting the orthodontic appliances and 24-48 hours, 2 weeks, and 5 weeks after the activation. Salivary DPD and BAP concentrations were determined by enzyme-linked immunosorbent assay. The data were analysed using non-parametric statistics. There were no statistically significant differences in salivary levels of biomarkers regarding demographic and clinical parameters. Overall, although DPD values revealed an increasing nature after force application and BAP values showed a descending trend, only the former showed statistically significant changes over time. Furthermore, p ost hoc comparisons for DPD salivary levels revealed significant differences between every paired sampling times, except for the pair baseline test/24-48 hours test. Synchronously, a moderate positive significant correlation between both salivary biomarkers was observed at 2 weeks test. The findings indicate that although salivary levels of DPD and BAP may act as indicators of increased bone remodelling, it appears that DPD dominates the earlier phases of OTM, whereas BAP might serve as indicator of bone formation as soon as the tooth movement stops.

Association of salivary levels of the bone remodelling regulators sRANKL and OPG with periodontal clinical status.

AIM: To determine the variations in salivary concentrations of sRANKL, osteoprotegerin (OPG) and its ratio, regarding the periodontal status. MATERIALS AND METHODS: Ninety-seven chronic periodontitis (CP) subjects and 43 healthy controls were selected. Periodontal status was assessed based on full-mouth clinical periodontal measurements. sRANKL and OPG salivary levels were analysed by ELISA. The association between these analytes and its ratio with CP was analysed individually and adjusted for confounding using a binary logistic regression model. RESULTS: sRANKL and sRANKL/OPG ratio were increased, whereas OPG was decreased in CP compared with healthy controls subjects. Although univariate analysis revealed a positive association of sRANKL salivary levels ≥6 pg/ml, OPG salivary levels ≤131 pg/ml and sRANKL/OPG ratio ≥0.062 with CP, after logistic regression analysis only the latter parameter was strongly and independently associated with disease status. Confounding and interaction effects of ageing and smoking habit on sRANKL and OPG levels could be noted. CONCLUSION: Although salivary concentrations of sRANKL, OPG and its ratio may act as indicators of the amount/extent of periodontal breakdown, the mutual confounding and synergistic biological interactive effects related to ageing and smoking habit of the susceptible host may also promote the tissue destruction in CP.

Assessment of clinicopathological characteristics and immunoexpression of COX-2 and IL-10 in oral pyogenic granuloma.

OBJECTIVE: The aim was to investigate the relationship between patient clinical background, histological features, and immunoexpression of COX-2 and IL-10 in oral pyogenic granuloma (PG). DESIGN: Paraffin-embedded samples of oral PG (n=57) were prepared for histological and immunohistochemical assessment. Based on the histological features, the samples were categorised into lobular capillary hemangioma (LCH) and non-LCH subtypes. The epithelial lining, angiogenic index, inflammatory infiltrate density, and interstitial fibrosis, were assessed in haematoxylin-eosin stained sections. In addition, the marker expression estimation (stained cells/total cell number) was used to assess immunoreactivity for each sample. RESULTS: Although there were no significant differences between histological subtypes regarding demographic and clinical parameters, mean values of microvessel count and inflammatory infiltrate density were significantly greater in the non-LCH PG subtype. Also, whilst cellular immunolocalisation patterns of COX-2 and IL-10 were similar, mean values of expression estimation of each immunomarker were significantly higher in non-LCH PGs in comparison with LCH subtypes. Furthermore, significant variations for immunohistochemical parameters were evident regarding to angiogenic index and inflammatory infiltrate density, but not concerning demographic and clinical data. Finally, linear regression analysis showed a significant positive correlation between the expression estimation of the two immunomarkers. CONCLUSION: These findings suggest a role for COX-2 and IL-10 in the etiopathogenesis of oral PG and indicate that LCH and non-LCH histological subtypes represent different stages in the evolution of a single lesion with varying degrees of proliferative, angiogenic, and inflammatory activity.

Salivary levels of matrix metalloproteinase (MMP)-9 and tissue inhibitor of matrix metalloproteinase (TIMP)-1: a pilot study about the relationship with periodontal status and MMP-9(-1562C/T) gene promoter polymorphism.

OBJECTIVE: Chronic periodontitis (CP) has been linked with an imbalance in the MMP-9/TIMP-1 ratio. A reasonable biologic explanation for this link is that the MMP-9 transcriptional activity can be modulated by MMP-9(-1562C/T) gene promoter polymorphism contributing to periodontal breakdown. This study aimed to assess the relationship between salivary MMP-9/TIMP-1 balance, MMP-9(-1562C/T) genotype and periodontal clinical status. DESIGN: Sixty-nine CP subjects and 54 healthy controls (HC) were selected. Periodontal status was assessed by criteria based on probing depth, clinical attachment level, extent, and severity of periodontal breakdown. Salivary levels of MMP-9 and TIMP-1 were analysed using ELISA and MMP-9(-1562C/T) genotype using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The association between salivary levels of MMP-9, TIMP-1 and MMP-9/TIMP-1 ratio with CP was assessed individually and adjusted for confounding using a binary logistic regression model. RESULTS: Significantly higher levels of both markers and their ratios were detected in the CP group in comparison to healthy controls. Synchronously, weak-to-moderate positive significant correlations between salivary biomarkers and clinical parameters were observed. After binary logistic regression analysis, salivary levels of MMP-9>20ngmL(-1), TIMP-1>64ngmL(-1) as well as MMP-9/TIMP-1 ratio >1 were independently associated with CP. Nevertheless, the MMP-9(-1562C/T) gene promoter polymorphism was not associated with the different degrees of chronic periodontitis and did not have influence on the salivary levels of biomarkers. CONCLUSION: The findings when considered within the limitations of this study may indicate that although a dominant expression of MMP-9 over TIMP-1 in saliva might reflect the periodontal clinical status, the functional polymorphisms in the promoter of the MMP-9(-1562C/T) gene from the Colombian population are not linked neither with significant salivary MMP-9 variations in these individuals nor periodontal clinical status.

Screening for subgingival occurrence of gram-negative enteric rods in periodontally diseased and healthy subjects.

OBJECTIVE: This study aimed to determine whether the variations in the occurrence of gram-negative enteric rods as detected through a longitudinal follow up with three consecutive visits, may be associated with the periodontal clinical status. DESIGN: Clinical and demographic parameters from 63 untreated chronic periodontitis (CP) subjects and 45 healthy controls (HC) were analyzed. Subgingival plaque samples were obtained from 6 sites in each subject at baseline, 1-week, and 1-month visits and processed using culture and biochemical tests. Culture findings were categorized taking into account the detection frequency of gram-negative enteric rods as persistent presence, transient presence, or absence of enteric rods in any sampling time. RESULTS: Although transient presence of gram-negative enteric rods was more prevalent in CP subjects (16.7%) than HC subjects (9.3%), the difference was not significant (P>0.05). The majority of subjects showed a transient presence of gram-negative enteric rods at concentrations <2 x 10(2)CFU/mL. Persistent presence of gram-negative enteric rods was not observed in any subject through the entire study period. Moreover, differences in both the detection frequencies of individual species and the total number of gram-negative enteric rods were not statistically significant neither inter- nor intragroups. CONCLUSION: The findings of the present study could indicate that gram-negative enteric rods are merely transient microorganisms within the subgingival environment and suggest that the periodontal clinical status appeared not to be influenced by the presence of these species.

Immunohistochemical expression of RANK, GRalpha and CTR in central giant cell granuloma of the jaws.

The aim was to evaluate the phenotypic expression of various cellular osteotropic factors in central giant cell granuloma (CGCG). Paraffin-embedded tissue from 27 aggressive and 10 non-aggressive cases of CGCG was assessed for the expression of RANK, GRalpha and CTR using immunohistochemistry. In addition, a staining-intensity-distribution (SID) score (proportion of stained cells x staining intensity) was used to assess immunoreactivity of each marker. The results showed that the multinucleated giant cells (MGC), mononuclear stromal cells (MSC) and endothelial cells were intensely positives for GRalpha, moderate for RANK and weak-to-moderate for CTR in all clinical groups, whereas spindle-shaped cells were intensely immunoreactive to GRalpha and unreactive to CTR and RANK. Although neither difference in RANK and GRalpha expression nor the SID score between the clinical forms of CGCG was observed, a statistically significant difference for CTR was evident. Furthermore, the comparison of the marker expression and SID score showed a significant correlation for all three markers within the clinical groups, except for GRalpha in the non-aggressive lesions where a weak and no significant correlation was detected. It was concluded that although the MGC share some similarities with the osteoclasts, they demonstrate phenotypic differences from each other that suggest a distinct precursor. The expression of RANK, GRalpha and CTR also suggest a role for these receptors in the resorptive activity of different cellular groups in CGCG and may lead to a more effective use of therapeutic inhibitors of bone resorption for the treatment of these disorders.