Detection of Microparticles of Different Origins in Implant Prostheses and Abutments.

PURPOSE: To assess whether particles from metal and other alloplastic materials detected in tissues surrounding dental implants could have other sources of origin besides biotribocorrosion or detachment from the implant surface. MATERIALS AND METHODS: A total of 52 prostheses were randomly tested at various stages of manufacture. Identification of the detached microparticles was performed using light field microscopy and comparison with previously obtained microscopic images. RESULTS: Microparticles of metallic, ceramic, plaster, polishers, or unidentifiable origin were detected in 49 prostheses (94%). CONCLUSION: Without an exhaustive decontamination protocol, prostheses and abutments carry metal microparticles and microparticles of other origins that could contribute to the development of peri-implant pathologies.

Current understanding of genetic polymorphisms as biomarkers for risk of biological complications in implantology.

BACKGROUND: In the last decade, multiple studies have been published that analyze the relationship between the risk of experiencing biological complications with implants and the presence of certain types of genetic polymorphisms. In the present report, we analyze the controversies that have arisen from this important area of investigation and synthesize the most prominent aspects of knowledge related to this possible etiopathogenic relationship. MATERIAL AND METHODS: For this review, the biomedical databases PubMed-Medline, SciELO, and DOAJ were used. Different search strategies were employed, from which 298 articles initially emerged. After refinement of the search, 55 articles published between 2002 and 2018 were finally selected based on relevance. RESULTS: In certain population groups, there is evidence to support that about a dozen polymorphisms could in some way be related to biological complications in implantology. Indeed, the results may vary according to the ethnic origin of the population studied. Most of the published investigations are initial studies reporting small sample sizes and utilizing different study group homogenization methods. We are still at a preliminary stage of our understanding and development with regard to these types of biomarkers. The interesting results identified indicate that new investigations will be necessary to eliminate the biases observed in some studies and to homogenize the research groups. In order to clarify the controversies surrounding the current knowledge in this field, we believe that it will be necessary to employ larger study groups and search for possible synergistic effects between different polymorphisms. Key words:Polymorphism, genetic markers, peri-implantitis, biological complication, dental implant.

Bone Remodeling around Implants Placed in Augmented Sinuses in Patients with and without History of Periodontitis.

BACKGROUND: Susceptible individuals may be more prone to bone loss after augmentation procedures. PURPOSE: Identify plausible clinical and biological factors influencing apical and marginal bone remodeling at implants placed in augmented sinuses, in patients with and without history of periodontitis. MATERIALS AND METHODS: This prospective cross-sectional clinical study analyzed implant bone levels in a group of 104 patients with and without history of periodontitis undergoing 139 sinus augmentation procedures. Marginal and apical bone loss (MBL/ABL) was measured post-loading using a standardized digital technique. Measurements were taken preoperatively, at second stage implant uncovery, one year after loading and at an average of 53-months follow-up. Odds ratios were calculated to evaluate risks factors of contributing variables, such as, smoking, history of periodontitis, membrane perforation, surgical approach, grafting material, use of PRP, and implant design/dimensions. RESULTS: Patients with history of periodontitis were 8.43 times more likely to present more than 2mm of MBL than patients without it (p =.041; CI95%: 1.09-65.12). Smokers were 4.97 times more likely to present over 2 mm of MBL than non-smokers (p =.003; CI95%: 1.70-14.54). Sinus membrane perforations were 11.4 times more likely to present ABL than those without perforation (p = 0.007; CI95%: 1.94-66.93). Mean MBL/ABL after 1-year post-loading and at last control were 0.49/0.56 mm and 0.67/0.46 mm, respectively. The use of a collagen membrane to cover the antrostomy and only xenograft as grafting material decreased ABL by 0.9 mm. The combination of autologous/xenograft bone was 4.04 times more likely to present higher ABL than xenograft alone (p = 0.023; CI95%: 1.21-13.45). Overall implant survival/success rates were 94.39%/91.33%, respectively. CONCLUSIONS: Smoking and previous history of periodontitis negatively affects implant MBL. Sinus membrane perforation was associated with higher ABL. Lack of association between bone remodeling at marginal and apical areas suggests that they are different and independent processes.

A Novel Mutation in a Patient with Hyperparathyroidism-Jaw Tumour Syndrome.

Hyperparathyroidism-jaw tumour syndrome (HPT-JT) is a rare variant of familial hyperparathyroidism, characterized by primary hyperparathyroidism (PHPT) due to one or multiple parathyroid adenomas, and benign tumours of the mandible and maxilla. It has an autosomal dominant pattern of inheritance, and is associated with mutations that deactivate the cell division cycle protein 73 homolog (CDC73) gene, also known as hyperparathyroidism 2 (HRPT2), located on the long arm of chromosome 1, that encodes for the tumour suppressor protein parafibromin. In the majority of cases, PHPT is the presenting symptom, but up to 30 % of HPT-JT cases initially present with an ossifying fibroma of the maxillofacial bones. HPT-JT may result in severe hypercalcemia-related complications and an elevated risk of parathyroid carcinoma. For this reason, early identification of the disease is important. We present the case of a 23-year-old woman who was found to have jaw tumours and was later diagnosed with PHPT. Genetic analysis revealed a novel mutation in exon 1 of CDC73. This report contributes to the understanding of the genetics of this rare syndrome. It also highlights the fact that HPT-JT should be considered and CDC73 mutation analysis should be performed in cases of early-onset PHPT associated with ossifying fibromas of the jaw.

Primordial odontogenic tumour: clinicopathological analysis of six cases of a previously undescribed entity.

AIM: To describe the clinicopathological and immuno-histochemical features of six tumours that do not fulfil the criteria of any of the currently classified odontogenic tumours. METHODS AND RESULTS: The patients were three males and three females, whose ages ranged from 3 years to 18 years (mean, 11.05 years). In all cases there were well-defined radiolucencies associated with unerupted teeth apparently showing a pericoronal relationship. Microscopically, all tumours were composed of variably cellular loose fibrous tissue with areas similar to dental papilla, entirely surrounded by cuboidal to columnar epithelium resembling the internal epithelium of the enamel organ. Mesenchymal tissue was positive only for vimentin, and Ki67 expression was very low (<2%). The epithelium was positive for CK AE1/AE3, CK5, CK14, and CK19, but negative for CK18 and CK20. All cases showed clear demarcation from the surrounding bone, and were surgically removed, with no recurrences after follow-up ranging from 6 months to 20 years. CONCLUSIONS: These findings differ from those observed in other odontogenic lesions, such as ameloblastic fibroma, odontogenic myxoma, odontogenic fibroma, and hyperplastic dental follicles. The term primordial odontogenic tumour is proposed to describe this novel lesion.

Ancient Schwannoma of the hard palate. An uncommon case report and review.

Schwannoma or neurilemmoma is an infrequent benign tumor in the oral cavity that originates from the Schwann cells on the neural sheath of the peripheral nerves. Schwannomas are frequently located in the soft tissues of head and neck region, but only a 1 to 12% of them are located in the oral cavity. Some histological variants of schwannoma have been described including the cellular, plexiform, epithelioid, ancient, and melanocytic types. The "ancient schwannoma" is an uncommon variant of this tumor that shows specific histological characteristics, and is rare in the oral cavity with less than 15 cases described on the literature. Most of them were located in the tongue or in the floor of the mouth, being the hard palate an extremely rare localization. We present a new clinical case of an ancient schwannoma with a long time of evolution, arising from the nasopalatine nerve, and located in the hard palate of a 35 year old female. We also review the main clinical and histological characteristics of this pathology. Key words:Ancient schwannoma, neurilemmoma, palate, schwannoma.

Bone microbial decontamination agents in osseous grafting: an in vitro study with fresh human explants.

BACKGROUND: Establishing a safe prophylactic antimicrobial protocol in bone grafting may enhance osseous volume outcomes. The purpose of this in vitro study is to assess human osteoblast response and safety after explant antimicrobial exposure. METHODS: Fresh human bone explants were exposed to three antimicrobials: povidone-iodine (PovI; 0.05%, 1%, and 5%), chlorhexidine (CHX; 0.2% and 1%), and sodium hypochlorite (NaOCl; 2.5%, 4.5%, and 5.25%) at different times (15, 30, 45, and 60 seconds) and concentrations to assess cellular toxicity. Explants were washed three times with saline after exposure. Controls, explants cultured in the absence of antimicrobials, were performed for all experimental situations tested. Trials were conducted in triplicate. Particle size influence on osteoblast growth was determined between bone fragments with a diameter <2 and ≥2 to 5 mm. Test and control groups were monitored by light microscopy to evaluate cellular growth. Osteoblast differentiation and morphology was assessed by alkaline phosphatase activity and scanning electron microscopy (SEM). RESULTS: Osteoblast growth was similar for particles <2 and ≥2 to 5 mm. Alkaline phosphatase control reference values were not significantly different from test groups (0.35 mU/mL ± 0.004 versus 0.34 mU/mL ± 0.009; P >0.05). Light microscopy showed on average 97% osteoblastic growth for bone particles exposed to PovI 5% and CHX 0.2% for all times and CHX 1% up to 30 seconds. The odds ratio of positive osteoblastic growth after a 30-second 2.5% NaOCl exposure was 2.4 times higher than after 5.25%. On average, one of two replicas yielded positive growth with 2.5% NaOCl and one of three with 5.25%. After 60-second explant exposure, positive osteoblastic growth was 7.7 times more likely to occur with 5% PovI or 0.2% CHX than with 5.25% NaOCl (P <0.05). SEM analysis confirmed light microscopy similar cellular adhesion and osteoblast phenotypic features between test and control groups. CONCLUSIONS: Best osteoblastic growth occurred after bone PovI exposure and CHX 0.2%. Cellular toxicity seems to be influenced by the type of antimicrobial, concentration, and exposure time. SEM analysis confirmed absence of osteoblast phenotypic alterations after exposure. Decontamination agents can safely be used in bone transplantation using up to 5% PovI and 0.2% CHX for 1 minute and CHX 1% for 30 seconds.

Overexpression of cyclooxygenase-2 as a biomarker in different subtypes of the oral lichenoid disease.

OBJECTIVE: Oral lichenoid disease (OLD) includes a number of chronic inflammatory processes including oral lichen planus (OLP) and oral lichenoid lesions (OLL) with controversial diagnosis and prognosis. Cyclooxygenase-2 (COX-2) is a key enzyme for inflammatory processes and cellular proliferation. Its overexpression in some premalignant chronic inflammatory diseases and malignant neoplasias could point to its potential as a prognostic factor. The aim of this study was to analyze the COX-2 expression in different subtypes of OLD because of its potential to be a marker of altered behavior. STUDY DESIGN: Forty-four samples from OLD patients were studied (30 females and 14 males) and classified according to their clinical (C1: only papular lesions/C2: papular and other lesions) and histological features (HT: OLP typical/HC: OLP compatible) according to published criteria. Standard immunohistochemical procedure was performed for COX-2 expression and a comparative and descriptive statistical analyses were performed. RESULTS: Epithelial COX-2 overexpression was observed in 24 (54.5%) cases (C1: 13 [54.2%]/C2: 11 [45.8%], HT: 9 [37.5%]/HC: 15 [62.5%], P = .032). Inflammatory COX-2 overexpression was observed in 14 (31.8%) cases (C1: 6 [42.9%]/C2: 8 [57.1%], HT: 4 [28.6%]/HC: 10 [71.4%], P = .032). CONCLUSION: Differences in COX-2 expression in subtypes of OLD may distinguish cases with a higher premalignant potential.

Simultaneous oral antral fistula closure and sinus floor augmentation to facilitate dental implant placement or orthodontics.

Several techniques have been used to treat the oroantral fistula with similar rates of success and failure. Some of them frequently present anatomical disadvantages. They can reduce vestibular depth, cause lack of support bone, or cause fusion of the Schneiderian and mucosal membranes. In this report, we present 3 cases of orosinusal fistulas successfully treated with a simultaneous closure of the communication and sinus floor augmentation. At the same time, this technique enables the restoration of the alveolar process with enough bone volume, which facilitates later implant surgery, prosthetic rehabilitation, or even some orthodontic treatments.

Cross-reactivity between Candida albicans and oral squamous cell carcinoma revealed by monoclonal antibody C7.

BACKGROUND: Monoclonal antibodies developed against Candida albicans cell wall mannoproteins cross-react with human ovarian cancer. These antibodies reacted with the nuclear pore complex protein Nup88, which is overexpressed in a number of human tumors. The aim of this study was to investigate if Nup88 revealed by monoclonal antibody C7 is overexpressed in early oral squamous cell carcinoma (EOSCC) and if this expression has a prognostic value. PATIENTS AND METHODS: A monoclonal antibody against a C. albicans cell wall manoprotein was used to investigate the expression of Nup88 in 34 EOSCC (T1/T2 N0M0). RESULTS: Mab C7 was mostly located in the cytoplasm and extracts from EOSCC showed specific bands of 47-40 and 70 kDa that were not observed in normal oral mucosa. The highest levels of Mab C7 reactivity were observed in 13 (38.2%) tumors. The Kaplan-Meier test showed the median survival time to be shorter in those EOSCC cases with the highest Mab C7 reactivity. CONCLUSION: The monoclonal antibody C7 raised against a C. albicans cell wall mannoprotein cross-reacts with an antigen from oral squamous cell carcinoma whose expression is associated with poor prognosis. The overexpression of this antigen is associated with a poor prognosis in early squamous cell carcinoma.

Granular cell tumor: report of 8 intraoral cases.

Granular cell tumor (GCT) is an uncommon neoplasm of controversial origin that can appear in any corporal localization, including the orofacial region. Although aggressive and malignant variants of this neoplasm have been described, most of GCTs are benign. In spite of the amount of research, the etiology of this neoplasm remains unclear and its histogenesis and its possible muscular, connective or neural origin has been broadly debated. In this paper 8 oral cases are presented, corresponding to 5 women and 3 men, with a mean age of 36.1 years old and a mean time of evolution of the lesions of 8.3 months. The most common localization was the tongue (75%). In all the cases a resection with safety margins of the lesions was carried out under local anesthesia. The samples were fixed and processed for histopathological study. The main clinicopathologic and diagnostic features of this neoplasm are reviewed and discussed.

Tumor de células granulares: presentación de 8 casoscon localización intraoral / Granular cell tumor: report of 8 intraoral cases

El Tumor de células granulares es una neoplasia de origen controvertido que puede aparecer en múltiples localizaciones corporales, incluyendo la región orofacial. El comportamiento de este infrecuente tumor es benigno en la mayor parte de los casos, aunque en ocasiones puede presentar agresividad local e incluso malignidad con afectación a distancia. Su etiología es actualmente solo parcialmente conocida y ha generado controversia desde sus primeras descripciones teorizando sobre un origen muscular, conectivo,etc o neural. En este trabajo se presentan 8 casos clínicos con localizaciónintraoral, correspondientes a 5 mujeres y 3 hombres, con una edad media de 36,1 años y en los que la localización principal fue la lengua (75%) y el tiempo medio de evolución de las lesiones fue de 8,3 meses. En todos los casos se realizó una exéresis de la lesión bajo anestesia local, con márgenes de seguridad adecuados y las muestras fueron procesadas para su estudio histopatológico. Los principales aspectos clinicopatológicos y diagnósticos en relación con esta patología son revisados y discutidos

Granular cell tumor (GCT) is an uncommon neoplasm of controversial origin that can appear in any corporal localization,including the orofacial region. Although aggressive and malignant variants of this neoplasm have been described, most of GCTs are benign. In spite of the amount of research, the etiology of this neoplasm remains unclear and its histogenesis and its possible muscular, conective or neural origin has been broadly debated. In this paper 8 oral cases are presented, corresponding to 5 women and 3 men, with a mean age of 36.1 years old and a mean time of evolution of the lesions of 8.3 months. The most common localization was the tongue (75%). In all the cases a resection with safety margins of the lesions was carried out under local anesthesia. The samples were fixed and processed for histopathological study. The main clinicopathologic and diagnostic features of this neoplasm are reviewed and discussed

Adamantiades-Behçet disease: an enigmatic process with oral manifestations.

Adamantiades-Behçet disease (ABD) is a chronic multisystemic vasculitis that is able to affect any human organ or system. Recurrent oral ulcers are a very important clinical sign. ABD is a worldwide pathology, which prevalence varies according to the population and geographic location. Although ABD has been known for ages, its aetiology remains an enigma. Genetic, immunological and microbiological factors have been associated. A wide spectrum of clinical manifestations (oral, genital, cutaneous, ocular, neurological, vascular and gastrointestinal) and an unpredictable evolution with repeated periods of exacerbation and remission are the most representative aspects of this pathology. The complex treatment of ABD requires a deep multidisciplinary cooperation; therefore, there is an extensive development of new therapeutic agents that have improved the prognosis of ABD. In this review were analysed the main etiological, clinical and therapeutic aspects of the disease.

Enfermedad de Adamantiades-Behçet: un proceso enigmático con manifestaciones orales / Adamantiades-Behçet disease: an enigmatic process with oral manifestations

La enfermedad de Adamantiades-Behçet es una vasculitis multisistémica crónica, potencialmente capaz de afectar a cualquier órgano o sistema del cuerpo humano y en la que la aparición repetida de úlceras orales es una de sus principales expresiones clínicas. La EAB es una patología de carácter universal, con una prevalencia variable en función de la población estudiada y que muestra una curiosa distribución geográfica. A pesar de ser un proceso conocido desde la antigüedad, su etiopatogenia en la que probablemente se hayan implicados factores genéticos, microbiológicos e inmunológicos, continua siendo enigmática. Su amplio espectro de manifestaciones clínicas orales, genitales, cutáneas, oculares, neurológicas, vasculares y gastrointestinalesy su impredecible evolución con periodos de exacerbación y de remisión son dos de los aspectos más representativos de esta patología. El complejo tratamiento de la EAB requiere una estrecha cooperación multidisciplinar dado su carácter multisistémico. Gracias a ello y al desarrollo de nuevos agentes terapéuticos su pronóstico ha mejorado sensiblemente con respecto a décadas pasadas. En esta revisión analizamos los principales aspectos etiopatogénicos, clínicos y terapéuticos de esta enfermedad

Adamantiades-Behçet disease (ABD) is a chronic multisystemic vasculitis that is able to affect any human organ or system. Recurrent oral ulcers are a very important clinical sign. ABD is a worldwide pathology, which prevalence varies according to the population and geographic location. Although ABD has been known for ages, its aetiology remains an enigma. Genetic, immunological and microbiological factors have been associated. A wide spectrum of clinical manifestations (oral, genital, cutaneous, ocular, neurological, vascular and gastrointestinal) and an unpredictable evolution with repeated periods of exacerbationand remission are the most representative aspects of this pathology. The complex treatment of ABD requires a deep multidisciplinary cooperation; therefore, there is an extensive development of new therapeutic agents that have improved the prognosis of ABD. In this review were analysed the main etiological, clinical and therapeutic aspects of the disease

Burning mouth syndrome in the Basque Country: a preliminary study of 30 cases.

OBJECTIVES: To know the most important clinical features of Burning Mouth Syndrome (BMS) in our environment. MATERIAL AND METHODS: A prospective study of 30 BMS patients, 29 female and 1 male, with a mean age of 60.2 years (range 37-89), was made. A previously designed clinical protocol, including blood counts, levadure culture, oral pH measurement and non-stimulated salivary flow rate, was completed by all patients. Comparative and descriptive statistical analysis was performed. The Chi-square test was applied (p< 0.05). RESULTS: Moreover of a burning sensation, 60 % of patients presented oral dryness and 60 % dysgeusia. The tongue was the most frequent site affected of burning sensation (66.7 %). Type II of BMS was the most common (53.3%). In women, 82.9 % were postmenopausal. A 13.3 % of patients suffered type II Diabetes, 6.7 % vitamin deficiency and 56.6 % used xerostomy-inducer medication. The 56.6 % of patients showed chronic anxiety and/or depression. The 46.7 % had a deficient oral hygiene level and 44.4 % wore inadequate dentures. Salivary flow rate was decreased in 50 % of patients. Significant levadure growth was not detected in any case. CONCLUSIONS: BMS patients in our environment are principally postmenopausal women, with tongue burning, xerostomy, dysgeusia and chronic anxiety and/or depression.

Factores clínico-patológicos en el carcinoma de células escamosas inicial de lengua, y suelo de la boca, en Vizcaya / Clinicopathological factors in early squamous cell carcinoma of the tongue and floor of the mouth, in Biscay (the Basque Country, Spain)

Objetivos: Conocer los principales datos clínico-patológicos presentes en los carcinomas de células escamosas (CCE) iniciales de la lengua y del suelo de la boca en Vizcaya, y su relación con el pronóstico.Diseño: Se ha realizado un estudio retrospectivo sobre 40 pacientes diagnosticados de CCE en estadios clínicos I/II de la lengua y el suelo de la boca. Se cumplimentó un protocolo previamente diseñado en el que se incluyeron datos clínicos e histopatológicos. Los datos fueron procesados estadísticamente, realizando un análisis descriptivo, comparativo, bi y multivariado y de supervivencia.Resultados: La edad media fue de 55,7 años (33-81) y las lesiones correspondieron a 34 hombres y 6 mujeres. En 23 casos el CCE se localizó en la lengua y en 17 en el suelo de la boca. El diámetro tumoral medio fue de 2,6 cm. El 65 por ciento de las neoplasias estaban ulceradas. El tiempo medio de evolución clínica fue de 3,4 meses. La velocidad media de crecimiento tumoral fue de 268. Eran fumadores 34 pacientes y consumían alcohol 33. Todos los CCE del suelo de la boca correspondían a pacientes fumadores y bebedores, así como todos los que mostraron recidivas regionales. La supervivencia a los 5 años fue del 65 por ciento. El 52,5 por ciento fueron CCE bien diferenciados. El grado histológico de malignidad medio fue de 1,96, y fue mayor en: varones, neoplasias linguales, T2, tumores con velocidad de crecimiento mayor de 200 y neoplasias recidivantes.Conclusiones: El CCE inicial de lengua y suelo de la boca en Vizcaya es una neoplasia predominante en los varones menores de 60 años, fumadores y consumidores de alcohol. Existe relación entre los datos histopatológicos y el pronóstico tumoral, preferentemente en los datos de modo y estadio de invasión (AU)