Plasma rich in growth factors (PRGF) and leukocyte-platelet rich fibrin (L-PRF): comparative release of growth factors and biological effect on osteoblasts.

PURPOSE: To compare the release of platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF-I) and interleukin 1ß (IL-1ß) of plasma rich in growth factors (PRGF) and leucocyte platelet-rich fibrin (L-PRF) and to evaluate their biological implication in osteoblasts. METHODS: Blood from 3 healthy volunteers was processed into PRGF, immediate L-PRF (L-PRF 0') and L-PRF 30 min after collection (L-PRF-30') and a control group. Growth factors release were analyzed at 7 times by ELISA. Cell proliferation, collagen-I synthesis and alkaline phosphatase activity were assessed in primary cultures of human osteoblasts. RESULTS: A slower controlled release of IGF-I, VEGF and PDGF was observed in the PRGF group at day 14. A higher synthesis of type I collagen was also quantified in PRGF. L-PRF released significantly higher amounts of IL-1ß, that was almost absent in the PRGF. CONCLUSIONS: The addition of leukocytes dramatically increases the secretion of proinflammatory cytokines, which are likely to negatively influence the synthesis of type I collagen and alkaline phosphatase (ALP) by osteoblasts.

Prognostic implications of preoperative systemic inflammatory markers in oral squamous cell carcinoma, and correlations with the local immune tumor microenvironment.

Purpose: The aim of this study was to investigate the prognostic significance of preoperative inflammatory markers in peripheral blood of patients with oral squamous cell carcinoma (OSCC), and to establish correlations with the infiltrate of macrophages and lymphocytes in the local immune tumor microenvironment (TME). Materials and Methods: Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), and systemic immune-inflammation index (SII) were retrospectively evaluated in a cohort of 348 OSCC patients, and correlated with overall (OS) and disease-specific survival (DSS). Immunohistochemical analysis of tumoral and stromal infiltration of CD8+, CD4+, FOXP3+ and CD20+ lymphocytes and CD68+ and CD163+ macrophages was performed in a subset of 119 OSCC patient samples, and correlations further assessed. Results: NLR, SII, and LMR were significantly associated with a poorer OS in univariate analysis; however, only NLR remained a significant independent predictor in the multivariate analysis (HR = 1.626, p = 0.04). NLR and SII were inversely and significantly correlated with stromal infiltration of CD8+, CD4+, and CD20+ lymphocytes. Moreover, a significant correlation between LMR was also found to significantly associate with stromal infiltration of CD8+, CD4+, and CD20+ lymphocytes, stromal CD68+ and CD163+ macrophages, and also tumoral infiltration of CD4+ and CD20+ lymphocytes. Conclusions: Preoperative NLR, SII, and LMR may serve as valuable systemic markers to predict OSCC patient survival, with NLR emerging as an independent predictor of poor OS. Moreover, strong significant correlations were exclusively observed between systemic inflammatory markers and the local stromal infiltration of lymphocytes in the TME.

Dabigatran: A new oral anticoagulant. Guidelines to follow in oral surgery procedures. A systematic review of the literature

BACKGROUND: Dabigatran is a newly commercialized drug that is replacing other anticoagulants in the prevention of venous thromboembolism, stroke and systemic arterial valve embolism. It acts directly on thrombin presenting in a dynamic and predictable way, which does not require monitoring these patients. Therefore, we consider the need to assess whether their use increases the risk of bleeding involved before any dental treatment. MATERIAL AND METHODS: We performed a systematic review with a bibliographic search in PubMed/Medline along with the Cochrane Library. We excluded articles dealing with all anticoagulants other than dabigatran, and works about surgical treatments in anatomical locations other than the oral cavity. RESULTS: We included a total of 13 papers of which 1 was a randomized clinical trial, 9 narrative literature reviews, 1 case series, 2 clinical cases and 1 expert opinion. Because we did not obtain any properly designed clinical trials, we were unable to conduct a meta-analysis. CONCLUSIONS: Currently, there is no consensus on the procedure to be followed in patients taking dabigatran. However, all authors agree to treat each case individually in accordance to the risk of embolism, postoperative bleeding and renal function. Also, it is necessary to perform minimally invasive interventions, and take the appropriate local anti-hemolytic measures

Clinical outcomes of peri-implant peripheral giant cell granuloma: a report of three cases.

BACKGROUND: Peripheral giant cell granuloma (PGCG) is a reactive lesion that occurs on the gingiva or alveolar mucosa and contains numerous giant cells. Its recurrence rate is 10%. Only five cases associated with dental implants have been reported. This case report describes three additional cases with clinical courses and outcomes. METHODS: Three women presented with a chief complaint of a gingival mass around the implants. The lesions were surgically excised under local anesthesia. RESULTS: The initial diagnosis at presentation was pyogenic granuloma. Radiography showed marginal bone loss accompanying the lesions. Histopathology confirmed the diagnosis of PGCG. In two cases, several recurrences resulted in explantation of the fixture. One case healed uneventfully. CONCLUSIONS: Despite its usually benign clinical behavior, peri-implant PGCG may follow an aggressive course. Treatment planning for this condition should take into account the presence of recurrences to evaluate the necessity of an aggressive surgical approach that may involve advanced bone loss and explantation. Further research on the origin of this implant-associated condition with a larger series of cases is necessary to provide a basis for adequate management.

Relación entre los niveles de cortisol salival y la presencia de xerostomía en mujeres menopaúsicas. Estudio preliminar / The relationship between the levels of salivary cortisol and the presence of xerostomia in menopausal women. A preliminary study

La xerostomía es un síntoma especialmente frecuente en las mujeres en torno a la menopausia, que se asocia en muchas ocasiones con estados depresivos.Objetivos: Valorar la relación entre las cifras del flujo salival total no estimulado y la presencia de xerostomía, y determinarlos niveles de cortisol salival y su relación con la misma.Diseño del estudio: Se seleccionaron 30 mujeres de los pacientes que acuden al Departamento de Medicina y Cirugía Bucofacial y se formaron dos grupos, estudio y control. Se recogieron muestras de flujo salival total no estimulado y mediante técnica de ELISA se determinaron las cifras de cortisol salival.Resultados: Las medias de flujo salival total no estimulado para el grupo control y estudio fueron de 0.37± 0.28 ml/min. y de 0.24± 0.18 ml/min. respectivamente. La concentración de cortisol salival fue de 3.47± 1.64 ng/ml. para el grupo control y de 2.29± 2.60 ng/ml. para el grupo estudio. Las pruebas estadísticas aplicadas no mostraron diferencias significativasentre los dos grupos del estudio para ambas variables.Conclusiones: Los resultados del presente estudio indican que no existe relación entre las variaciones en el flujo salival total no estimulado y las concentraciones de cortisol correspondientes

Xerostomia is a particularly frequent occurrence among menopausal women, and is often associated with depression.Objectives: To evaluate the relationship between unstimulated salivary flow rate and the presence of xerostomia, and to determine the levels of salivary cortisol and its relationship with xerostomia.Study design: Thirty women were selected from patients attending the Department of Medicine and Buccofacial surgery, and formed into two groups, study and control. Samples of unstimulated salivary flow were collected, and the amounts of salivary cortisol determined using the ELISA technique (enzyme-linked immunosorbent assay).Results: The mean unstimulated salivary flow rates for the control and study group were 0.37 ± 0.28 ml/min and 0.24 ± 0.18 ml/min, respectively. The concentration of salivary cortisol was 3.47 ± 1.64 ng/ml for the control group and 2.29 ± 2.60 ng/ml for the study group. The statistical tests applied showed no significant differences for either variable between the two groups in the study