The effects of miniscrew-assisted rapid palatal expansion on the upper airway of adults with midpalatal suture in the last two degrees of ossification.

BACKGROUND: Transverse deficiencies of the maxillary basal bone have been treated in adult patients using miniscrew-assisted rapid palatal expansion (MARPE) therapy. However, the midpalatal suture's degree of ossification may affect the upper airway dimensions. This study compared the volumetric changes of the total upper, retropalatal, retroglossal airways, and the minimal transverse airway constriction after MARPE therapy in patients with midpalatal suture in the last stages of ossification. METHODS: This controlled clinical trial included a total of 20 adult patients (mean age 24.5 ± 6.2 years) with maxillary atresia treated with MARPE. Preoperative (T0) cone-beam computed tomography scans were used to determine the degree of midpalatal suture ossification. Two groups were formed considering the last two stages of sutural ossification "D" or "E" (n = 10 per group). After 120 days of the therapy (T1), cone-beam computed tomography assessments were performed to compare the pre and post-treatment outcomes. The total upper, retropalatal, and retroglossal airways and the minimal transverse airway constriction were evaluated. The three-dimensional reconstruction was performed with OsiriX MD software. The comparisons were carried out using mixed models for repeated measures at fixed time points (α = 0.05). RESULTS: Groups D and E showed no significant difference for any of the analyzed parameters (P > 0.05). Both groups showed a statistically significant increase for all airway segments after the treatment with MARPE (P < 0.05). The total upper airway increased (11.6% and 16.1%) for groups D and E, respectively (P = 0.3356). CONCLUSIONS: MARPE therapy resulted in dimensional gains of the upper airway for adult patients, irrespective of the intermaxillary sutural degree of ossification.

Dentoskeletal changes and their correlations after micro-implant-assisted palatal expansion (MARPE) in adults with advanced midpalatal suture ossification.

OBJECTIVES: To evaluate and correlate the dentoskeletal changes of adult patients after miniscrew-assisted rapid palatal expander (MARPE) in the two final stages of midpalatal suture ossification. MATERIALS AND METHODS: This interventional pre-post clinical study consisted of 20 adults (24.9±1.8 years), with transverse maxillary atresia, divided into two subgroups (n=10) based on the ossification degree of the midpalatal suture: stage D, fusion completed in the palatine bone; and stage E, fusion anteriorly in the maxilla. Cone beam computed tomography (CBCT) in the pre- (T0) and post-treatment (T1) time intervals were used to evaluate the anterior and posterior sutural opening, activation of the expander screw, vestibular-lingual inclinations, and widths of first premolars and first molars. Maxillary interincisor diastema was measured on patients' plaster models in the same timepoints. The Wilcoxon-Mann-Whitney test, generalized linear models (GLM), and chi-square (χ2) test were employed. RESULTS: All variables significantly increased after MARPE therapy regardless of the ossification degree (P<0.05). Patients with stage D suture presented wider interincisal diastema and maxillary suture opening (on both regions, anterior and posterior) when compared with patients with stage E (P<0.05). Maxillary interincisor diastema was positively associated with anterior and posterior suture opening for all subjects (P<0.05). MARPE therapy was unsuccessful in six patients, mostly presented by individuals with E maturation stage of the midpalatal suture. CONCLUSIONS: After MARPE, a significant correction in the transverse defect of the maxillary basal bone was achieved for adults in the last two midpalatal suture maturation stages. CLINICAL RELEVANCE: Adult patients in stage D of maxillary suture ossification are more susceptible to dentoskeletal changes following MARPE therapy as compared to patients with stage E.

Silver nanoparticles formulations for healing traumatic injuries in oral mucosa of rats.

OBJECTIVE: To evaluate formulations of 1 % silver (Ag) nanoparticles for treating traumatic lesions induced in the oral mucosa of rats, because these lesions are commonly observed in the dental clinic, and their therapeutic forms are scarce. METHODS: Wistar rats were punch-injured (two circular fragments, 4.0 mm in diameter) in the oral mucosa (one on each side), and were treated topically (twice per week) with the treatments/groups including: no injury, control, vehicle, diluted Ag, soluble Ag, and solid Ag. On the 2nd, 7th, and 14th days postinjury, biopsies were collected for immunohistochemistry and biochemical analysis. RESULTS: The group diluted Ag revealed a higher level of inflammatory infiltrate on the 2nd day, whereas solid Ag presented lower levels. The Ag solid group presented higher IL-1ß on the 2nd day and increased IL-10 and TGF-ß1 throughout the follow-up. Moreover, all three Ag groups presented lower levels of oxidative stress markers and, on the 7th day, the diluted Ag and solid Ag groups revealed higher antioxidants. Diluted Ag and soluble Ag groups presented greater blood vessels proliferation, whereas soluble Ag and solid Ag groups revealed greater VEGF on the 2nd and 14th days. Furthermore, all three Ag groups were highlighted during fibroplasia, although collagenesis was similar to that observed in the control group. CONCLUSIONS: Although diluted Ag was noticeable for its important angiogenesis and fibroplasia, solid Ag was the most suitable formulation in healing oral lesions as it efficiently controlled inflammation and oxidative stress, thus favoring angiogenesis and tissue formation.

Anti-inflammatory and antimicrobial effects of Zingiber officinale mouthwash on patients with fixed orthodontic appliances.

INTRODUCTION: This study aimed to assess the anti-inflammatory and antimicrobial effects of mouthwashes with 0.12% chlorhexidine (CLX) and 0.5% Zingiber officinale essential oil (ZOEO). METHODS: The gas chromatography-mass spectrometry of ZOEO was developed, and the mouthwash was prepared. Thirty-one adult subjects of both sexes with fixed orthodontic appliances were selected. For 7 days, the mouthwashes with CLX, ZOEO, and flavored sterile water placebo were used randomly, with a 15-day interval between each solution. Saliva was collected before the first mouthwash, 1 minute and 15 minutes after it, and on the seventh day. The patients were subjected to clinical examinations of the bonded bracket index proposed by Ciancio, bleeding on probing, and sensory analysis (flavor). Generalized linear models were used to assess in vitro cell viability. The GENMOD procedure was used to assess the changes of bleeding on probing, and Friedman and Wilcoxon tests were used for data on colony-forming units per milliliter (CFU/mL), bonded bracket index, and flavor, at the 5% significance level. RESULTS: In the microbiologic analysis, the ZOEO mouthwash presented antimicrobial effectiveness for Streptococcus mutans as well as the CLX mouthwash, but it did not show the same substantivity. The ZOEO was efficient in controlling dental biofilm and reducing gingival bleeding. The sensory analyses showed that the flavor for ZOEO and CLX solutions presented low acceptability. CONCLUSIONS: The ZOEO mouthwash has an anti-inflammatory property with an effect on reducing gingival bleeding. However, it requires adjustments to the formulation to improve flavor quality.

Antimicrobial effect of Melaleuca alternifolia dental gel in orthodontic patients.

The aim of this study was to evaluate the antimicrobial effect and sensorial analysis of the gel developed with the essential oil of Melaleuca alternifolia. Thirty-four volunteers, divided into 2 groups, were monitored for 4 weeks. Initially, clinical biofilm (plaque index) and saliva samples (bacteria count) were collected, from which the standard values for each patient were obtained. For 7 days, group 1 used the melaleuca gel (Petite Marie/All Chemistry, São Paulo, Brazil), and group 2 used Colgate Total (S.B. Campo, São Paulo, Brazil). After 7 days, the plaque index was performed again, as well as the bacteria count and the sensorial analysis (appearance, color, odor, brightness, viscosity, and first taste sensation). The volunteers were instructed to return to their usual dental hygiene habits for 15 days. After this, group 1 started using Colgate Total, and group 2 started using the melaleuca gel, with the same evaluation procedures as the first week. The data were analyzed statistically with a significance level of 5%. In the bacteria count and clinical disclosure, the melaleuca gel was more effective in decreasing the dental biofilm and the numbers of bacteria colonies. According to the data from the sensory evaluation, Colgate Total (the control) showed better results regarding flavor and first sensation (P <0.05). We concluded that melaleuca gel is efficient in bacteria control but needs improvement in taste and first sensation.

Structural properties induced by the composition of biocompatible phospholipid-based microemulsion and amphotericin B association.

Anionic microemulsions (MEs) containing soya phosphatidylcholine, Tween-20, sodium oleate as surfactant, and cholesterol as oil phase were investigated as drug carriers for amphotericin B. Depending on the composition of the microemulsion, various structures, which differently interact with amphotericin B, can be formed. The nanostructured systems were characterized by photon correlation spectroscopy, rheological behavior, and polarized light microscopy. The results reveal that the droplet diameters increased with amphotericin B incorporation for all ranges of surfactant and oil phase. For both amphotericin B-unloaded and amphotericin B-loaded microemulsions, the profile of the oil droplet diameter decreased with increasing the surfactant concentration, demonstrating the stabilizing effect of the surfactant. The increase in the oil phase proportions led to the growth of the droplet diameter, clearly demonstrating the limit of the surfactant organization in the oil-water interface. The amphotericim B incorporation into microemulsion increased with the fraction volume of the oil phase and the surfactant concentration reaching a plateau at high contents. This profile could be quantitatively analyzed by the framework of the pseudo-phase model that considers the amphotericim B distribution between the oil and the aqueous phases. The rheological analysis showed a pseudoplastic behavior with little thixotropic characteristic. Under polarized light, the system of interest showed a dark background characteristic of dispersed droplets. However, for both amphotericim B-loaded and amphotericim B unloaded microemulsions, the increase in the O/S ratio led to the formation of ordered structures with lamellar arrangements.