Decision Making in the Restoration of Endodontically Treated Teeth: Effect of Biomimetic Dentistry Training.

The restoration of endodontically treated teeth (ETT) is challenging as these teeth often present with structural deficiencies. Currently, there is no consensus regarding the final restoration choice. Historically, the full coverage crown was the universally selected treatment for endodontically treated teeth. With advances in adhesive and biomimetic dentistry, more minimally invasive treatment modalities have become a viable option. With this study, we aim to understand the restorative decision of the general dentist with or without additional training in biomimetic dentistry. Seventy-eight general dentists, with or without biomimetic training, were surveyed to determine their restorative preferences on five extracted posterior teeth, categorized according to volumetric loss of tooth structure, as indicated by the number of missing walls, the isthmus width, the presence or absence of marginal ridges, and cusps. CAD/CAM reconstructions were made with the teeth to analyze the volume of tooth loss and compare these with the survey results. Data were compared using the chi-squared test and Fisher's exact test. The frequency of responses recommending a crown and the volume of tooth loss were correlated using the Pearson test (p < 0.05). For all five teeth, survey responses showed a statistically significant difference in the restorative decision of full coverage versus alternative restorations, with biomimetic dentists selecting a direct restoration or inlay/onlay in lieu of a full coverage crown (n = 63, p < 0.05). The age of the participant did not have a significant impact on the restorative decision making process for these teeth. The biomimetic trained dentists showed a greater tendency to select a crown option only when the volume of tooth loss was greatest, otherwise their restorative decisions tended towards the conservative treatment options. This study also demonstrates a novel method of digitally developing a volume of tooth loss to compare against the visual interpretation of the volume of tooth loss.

Chapter 8: Risk Assessment: Considerations for Coronal Caries.

Caries risk assessment (CRA) is essential to delivering personalized/precision care in caries management. Limited formal evaluation and validation of existing CRA tools affects the ability to accurately predict new lesions. However, this should not prevent clinicians from assessing modifiable risk factors to guide preventive measures and address individual needs to personalize care. Since caries is a multifactorial and dynamic disease process, CRA is complex and impacted by multiple variables throughout the life course, demanding periodic re-assessment. Many factors can influence caries risk at the individual, family, and community level; however, unfortunately, caries experience is still considered one of the greatest indicators of future risk for caries. CRA tools that are validated, inexpensive, and easy to use should be developed and prioritized to help support decision-making to implement evidence based, and minimally invasive caries management strategies for coronal caries lesions in children, adults, and older persons. Efforts into developing CRA tools should include evaluation and reporting of internal and external validation information. In the future, approaches using big data and artificial intelligence may drive risk predictions, and cost-effectiveness analyses may help derive the selection of appropriate risk thresholds for decision-making. Because of the importance of CRA in the treatment planning and decision-making process, challenges for implementation including how to communicate risk to drive behavior change, development of tools that are quick and easy to integrate seamlessly into the busy clinical flow, and reimbursement for the time needed to implement should be considered.

Caries Management in Special Care Dentistry.

The objective of this article is to provide a summary of the current evidence-based recommendations for caries management in patients with special health care needs (SHCNs). Considerations regarding caries risk assessment and preventive measures are also discussed with the goal of helping clinicians to manage the caries disease process using a person-centered approach and risk-based interventions. Importantly, most of the evidence is still based on the general population, because the evidence for those with SHCNs is still limited.

Mucoepidermoid carcinoma mimicking a mucocele (ranula) in the floor of the mouth.

Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy. The submandibular gland is rarely involved, about less than 10% of all other major salivary glands. We report a case of a 49-year-old female who presented with a mass on the left side of the floor of the mouth. She was complaining of neck pain for the last 2-3 days and had noticed the mass growing in size and becoming tender to palpation. There was no exacerbation of pain during eating, drinking, or opening of mouth. A multidetector CT scan was made. The radiographic examination revealed a mostly well-defined hypodense area suggestive of mucocele (ranula), which was thought to be corroborated by the clinical findings. The treatment of choice was the complete excision of the mucocele and the left submandibular salivary gland. The histopathological examination surprisingly revealed a low-grade MEC. No further treatment was recommended; however, a follow up was scheduled in 4 months. This atypical location of MEC in the floor of the mouth simulated the clinical and radiographic features of a mucocele. This case highlights the value and importance of using all the available diagnostic tools and modalities for optimal patient management, as the histopathological analysis played an important role to confirm the diagnosis.

Endothelial cell-derived interleukin-6 regulates tumor growth.

BACKGROUND: Endothelial cells play a complex role in the pathobiology of cancer. This role is not limited to the making of blood vessels to allow for influx of oxygen and nutrients required for the high metabolic demands of tumor cells. Indeed, it has been recently shown that tumor-associated endothelial cells secrete molecules that enhance tumor cell survival and cancer stem cell self-renewal. The hypothesis underlying this work is that specific disruption of endothelial cell-initiated signaling inhibits tumor growth. METHODS: Conditioned medium from primary human dermal microvascular endothelial cells (HDMEC) stably transduced with silencing RNA for IL-6 (or controls) was used to evaluate the role of endothelial-derived IL-6 on the activation of key signaling pathways in tumor cells. In addition, these endothelial cells were co-transplanted with tumor cells into immunodefficient mice to determine the impact of endothelial cell-derived IL-6 on tumor growth and angiogenesis. RESULTS: We observed that tumor cells adjacent to blood vessels show strong phosphorylation of STAT3, a key mediator of tumor progression. In search for a possible mechanism for the activation of the STAT3 signaling pathway, we observed that silencing interleukin (IL)-6 in tumor-associated endothelial cells inhibited STAT3 phosphorylation in tumor cells. Notably, tumors vascularized with IL-6-silenced endothelial cells showed lower intratumoral microvessel density, lower tumor cell proliferation, and slower growth than tumors vascularized with control endothelial cells. CONCLUSIONS: Collectively, these results demonstrate that IL-6 secreted by endothelial cells enhance tumor growth, and suggest that cancer patients might benefit from targeted approaches that block signaling events initiated by endothelial cells.

Endothelial derived factors inhibit anoikis of head and neck cancer stem cells.

Recent evidence demonstrated that cancer stem cells reside in close proximity to blood vessels in human head and neck squamous cell carcinomas (HNSCC). These findings suggest the existence of a supporting perivascular niche for cancer stem cells. The purpose of this study was to evaluate the effect of endothelial cell-secreted factors on the behavior of head and neck cancer stem-like cells (HNCSC). HNCSC were identified by sorting UM-SCC-22A (cell line derived from a primary squamous cell carcinoma of the oropharynx) and UM-SCC-22B (derived from the metastatic lymph node of the same patient) for CD44 expression and ALDH (aldehyde dehydrogenase) activity. HNCSC (ALDH+CD44+) and control (ALDH-CD44-) cells were cultured in ultra-low attachment plates in presence of conditioned medium from primary human endothelial cells. ALDH+CD44+ generated more orospheres than control cells when cultured in suspension. The growth factor milieu secreted by endothelial cells protected HNCSC against anoikis. Mechanistic studies revealed that endothelial cell-secreted vascular endothelial growth factor (VEGF) induces proliferation of HNCSC derived from primary UM-SCC-22A, but not from the metastatic UM-SCC-22B. Likewise, blockade of VEGF abrogated endothelial cell-induced Akt phosphorylation in HNCSC derived from UM-SCC-22A while it had a modest effect in Akt phosphorylation in HNCSC from UM-SCC-22B. This study revealed that endothelial cells initiate a crosstalk that protect head and neck cancer stem cells against anoikis, and suggest that therapeutic interference with this crosstalk might be beneficial for patients with head and neck cancer.

Células-tronco na saúde e na doença / Stem cells in health and disease

Células-tronco foram recentemente caracterizadas como componentes fundamentais parao desenvolvimento e função de órgãos e tecidos do corpo humano. O descontrole nos processos de diferenciação e sobrevivência das células-tronco tem sido caracterizado como fator etiológico importante em alterações de desenvolvimento do complexo crânio-facial. O conhecimento gerado através de estudos feitos nesta área levantaram a possibilidade de se utilizar células-tronco terapeuticamente para regeneração de tecidos da cavidade oral. Por outro lado, células-tronco também foram caracterizadas em patologias importantes como o câncer. Em câncer, células-tronco participam dos processos de progressão tumoral, bem como na resistência a terapias uma vez que estas células são resistentes a quimioterapia convencional. Tanto em regeneração de tecidos quanto em câncer, é fundamental que se tenha uma compreensão profunda dos mecanismos que governam o comportamento das células-tronco para que se possa desenvolver terapias que sejam seguras e eficazes para os pacientes. O objetivo principal desta revisão é discutir o papel das células tronco em saúde e na doença, usando a regeneração de tecido pulpar e o câncer oral como exemplos de relevância no contexto de Odontologia.

Stem cells were recently characterized as critical components of the development and function of most tissues and organs in humans. Indeed, deregulated survival and differentiation of stem cells have been characterized as important etiological factors of developmental anomalies in the craniofacial region. This knowledge raised the possibility that stem cells could be useful for the therapeutic regeneration of oral tissues. On the other hand, stem cells appear to have an important role in tumor progression, as well as in the resistance of cancer to therapy. This might be due to the fact that stem cells are resilient, long-lived, and tend to survive to conventional chemotherapeutic drugs. Both, in tissue regeneration and in cancer, it is critical to have a profound understanding of the mechanisms that regulate the behavior of stem cells to develop therapies that are safe and effective for patients. The main objective of this review is to discuss the role of stem cells in health and disease, using dental pulp tissue regeneration and oral cancer as examples of relevance to Dentistry.

Metronomic small molecule inhibitor of Bcl-2 (TW-37) is antiangiogenic and potentiates the antitumor effect of ionizing radiation.

PURPOSE: To investigate the effect of a metronomic (low-dose, high-frequency) small-molecule inhibitor of Bcl-2 (TW-37) in combination with radiotherapy on microvascular endothelial cells in vitro and in tumor angiogenesis in vivo. METHODS AND MATERIALS: Primary human dermal microvascular endothelial cells were exposed to ionizing radiation and/or TW-37 and colony formation, as well as capillary sprouting in three-dimensional collagen matrices, was evaluated. Xenografts vascularized with human blood vessels were engineered by cotransplantation of human squamous cell carcinoma cells (OSCC3) and human dermal microvascular endothelial cells seeded in highly porous biodegradable scaffolds into the subcutaneous space of immunodeficient mice. Mice were treated with metronomic TW-37 and/or radiation, and tumor growth was evaluated. RESULTS: Low-dose TW-37 sensitized primary endothelial cells to radiation-induced inhibition of colony formation. Low-dose TW-37 or radiation partially inhibited endothelial cell sprout formation, and in combination, these therapies abrogated new sprouting. Combination of metronomic TW-37 and low-dose radiation inhibited tumor growth and resulted in significant increase in time to failure compared with controls, whereas single agents did not. Notably, histopathologic analysis revealed that tumors treated with TW-37 (with or without radiation) are more differentiated and showed more cohesive invasive fronts, which is consistent with less aggressive phenotype. CONCLUSIONS: These results demonstrate that metronomic TW-37 potentiates the antitumor effects of radiotherapy and suggest that patients with head and neck cancer might benefit from the combination of small molecule inhibitor of Bcl-2 and radiation therapy.

Removal of a partial denture from the esophagus with the aid of an endoscope.

Swallowed prostheses have been described in the literature, and in some cases, the diagnosis can be challenging, especially if the partial or complete denture is metal-free. This article presents a case of a swallowed partial denture and points to the importance of early diagnosis. A man was admitted to the emergency room complaining of progressive breathing difficulty while presenting with an extra volume in his neck. After inconclusive image examinations, endoscopy under sedation was used to identify and retrieve the foreign object, which was a metal-free acrylic partial denture. Early diagnosis and the correct treatment can avoid serious sequelae, such as edematous reactions, mucosal infection, and necrosis. Patients should be scheduled for regular recall visits for evaluation of prosthesis fit and retention, condition of the abutments, and nocturnal wear.

Pseudolipoma in an 18-month-old Caucasian girl: no trauma reported.

We report a pseudolipoma in an 18-month-old Caucasian girl without history of trauma. Clinical and histological findings are discussed and the literature is reviewed.

Symptoms of craniomandibular disorders in elderly Brazilian wearers of complete dentures.

OBJECTIVE: Investigate the incidence of symptoms of craniomandibular disorder in elderly Brazilian wearers of full dentures. DESIGN: In this cross-sectional study, a questionnaire based on Helkimo's anamnestic index was applied to a group of 65-year-olds or older individuals who wear a set of full dentures. SETTING: Interviews were carried out at the dental clinics of the University of Taubaté and the University of Vale do Paraíba, Brazil. SUBJECTS: From a total of 384 patients, 84 elderly wearers of full dentures were interviewed. MAIN OUTCOME MEASURES: The questionnaire identified the most commonly related symptoms of craniomandibular disorders. RESULTS: The patient's average age was 73.5 years (ranging from 65 to 89 years), 81% of them females. Only 5% reported pain when opening their mouths, and the same percentage complained of temporomandibular joint luxation and a sensation of tired muscles during mastication. Similar rates were found for pain in the temporomandibular joint area (6%), pain in the temporal muscle area (7%), difficulty to move the mandible in the morning (4%) and pain during excursive (protrusive and lateral) movements (8%). The highest rates were found for pain in the masseter muscle area (39%) and articular noises (24%). CONCLUSION: The incidence of craniomandibular disorder symptoms was low in this group of elderly wearers of full dentures, except for pain in the masseter (39%) and articular noises (24%).

Programa de inseminaçäo artificial heteróloga com sêmen criopreservado / Heterologous artificial insemination program with cryopreserved semen

Existem poucos tratamentos efetivos na correçao da infertilidade masculina e a mais freqüente e efetiva terapia usada é a inseminaçao artificial com sêmen de doador. Atualmente é mandatório o uso de sêmen congelado, após um período de "quarentena", para reduzir a transmissao de doenças sexualmente transmissíveis. O objetivo deste estudo foi descrever a técnica de criopreservaçao e os resultados obtidos com inseminaçao heteróloga utilizando sêmen criopreservado. Foram realizados 11 ciclos de inseminaçao em sete pacientes cujos maridos eram azoospérmicos. A taxa média de sobrevida dos espermatozóides após o congelamento - descongelamento foi de 77,45 mais ou menos 11,08 por cento. O número de espermatozóides móveis inseminados variou de 1,35 a 18,45 x 10 (u = 6.13 mis ou menos 4.41 x 10) por aplicaçao. A taxa de gravidez/ciclo foi de 27,27 por cento (três gestaçoes, sendo uma gemelar e duas simples). A técnica de criopreservaçao de esperma utilizada mostrou-se eficaz, de manuseio simples e de baixo custo operacional. Na tentativa de atenuarmos o efeito deletério do processo de congelamento - descongelamento sobre as taxas de gravidez, algumas medidas poderiam ser seguidas: duas inseminaçoes por ciclo, uma poliovulaçao controlada, um adequado timing na inseminaçao e uma adequada técnica de capacitaçao, espermática.

Taxas de gestaçäo após inseminaçäo tubo-uterina com espermatozóides capacitados em fluido folicular humano ou Menezo B2 / Pregnancy rates after tube-uterine insemination with capacited spermatozoa in human follicular fluid or Menezo B2

No presente trabalho, os autores avaliaram a eficiência da inseminaçao artificial homóloga utilizando espermatozóides no fluido folicular humano. Um total de 39 casais inférteis foram, de forma prospectiva e randomizada, submetidos a 54 ciclos de inseminaçoes tubo-uterinas com espermatozóides capacitados em fluido folicular humano e 29 ciclos no grupo do Menezo B2. A taxa de gravidez/ciclo foi de 8,0 por cento (2/25) quando se utilizou o fluido folicular humano versus 13,7 por cento (4/29) quando se utilizou o Menezo B2, nao havendo diferença significativa (p=0.51) entre os dois grupos. Em conclusao, a capacitaçao dos espermatozóides em fluido folicular nao mostrou vantagens sobre a executada com o meio de cultura Menezo B2.

Influência da qualidade dos embriöes na taxa de gravidez de um programa de fertilizaçäo in vitro / Influence of embryos quality on the pregnancy rate of a program for in vitro fertilization

Esse trabalho avalia a relaçao entre a qualidade dos embrioes transferidos e a taxa de gravidez num programa de fertilizaçao in vitro (FIV). Um total de 119 ciclos de FIV com transferência embrionária foi analisado. Os embrioes obtidos foram classificados em graus morfológicos segundo as características dos blastômeros (fragmentaçao, regularidade e número). Nas pacientes que engravidaram (n=34) o grau médio de qualidade dos embrioes transferidos (4,2.ñ 1,O) foi superior (P < O,01) ao obtido (3,8 ñ 1,1) para as nao-grávidas (n=85). Em conclusao, existe uma forte correlaçao entre a qualidade dos embrioes transferidos e a taxa de gravidez num programa de FIV.

Influência da morfologia espermática nas taxas de clivagem de embriöes num programa de fertilizaçäo in vitro / Influence of the sperm morphology in the embryo cleavage rates in in vitro fertilization program

Um total de 102 ciclos de FIV em 83 pacientes foi analisado, com o objetivo de avaliar a influência da morfologia do espermatozóide nas taxas de clivagem de embrioes, num programa de fertilizaçao in vitro. Os ciclos estudados foram divididos em dois grupos. O grupo A com 30 por cento ou mais de espermatozóides normais (83 ciclos), e o grupo B com menos de 30 por cento de espermatozóides normais (19 ciclos). Em ambos os grupos, a avaliaçao inicial do esperma apresentava uma concentraçao ( 20 X 10(6) de espermatozóides/ml e uma motilidade progressiva - 30 por cento. A taxa de clivagem foi significativamente maior (p=0,000) no grupo A (67,63 + 30,54 por cento) do que no grupo B (36,98 + 36,61 por cento), e o número de ciclos em que nao houve formaçao de embrioes foi maior no grupo B do que no A (p=0,0002).

Pode a dificuldade no ato da transferência embrionária alterar o índice de gravidez de um programa de fertilizaçäo in vitro? / Can a difficult mebryo transfer procedure change the pregnancy rate of the in vitro fertilization program?

Este trabalho testou a hipótese de que a dificuldade no ato da transferência embrionária poderia alterar o índice de gravidez num programa de fertilizaçao in vitro. Assim sendo, um total de 79 transferências embrionárias foram analisadas quanto à complexidade de execuçao, e divididas em dois grupos: a) Quando a transferência embrionária é considerada tecnicamente fácil (passagem cervical de cateteres de Frydman sem resistência) - 52 casos. b) Quando a transferência embrionária é considerada tecnicamente díficil(necessidade de manipulaçao para a passagem de cateteres de Frydman ou uso de cânula metálica) - 27 casos. O índice de gravidez no grupo A (32,69 por cento por transferência) foi significativamente maior (p

Pode o teste de penetraçäo dos espermatozóides no muco cervical bovino predizer o resultado do teste pós-coito? / Can the sperm penetration test on the bovine cervical mucus to predict the result of postcoital test?

O trabalho analisa o valor preditivo do teste de penetraçao dos espermatozóides no muco cervical bovino (TMCB) e a posterior performance no teste pós-coito (TPC). O total de 31 casais foi analisado. Inicialmente, os maridos realizaram o TMCB, em seguida, suas esposas foram submetidas ao TPC. Os resultados obtidos mostram que o TMCB anormal identifica com precisao os pacientes que, posteriormente, apresentaram TPC anormal. A eficiência do TMCB foi de 0,73.

Influência da idade da paciente nos resultados de um programa de fertilizaçäo in vitro / Influence of patient's age in the results of in vitro fertilization program

Uma análise da influência da idade das pacientes nos resultados de um programa de fertilizaçao in vitro foi realizada após 100 procedimentos. A idade está relacionada com decréscimo nas taxas de gravidez em pacientes ( 35 anos, quando comparadas com aquelas de < 35 anos (p = 0,0015). A idade da mulher deve ser considerada como um fator prognóstico importante, quando a fertilizaçao in vitro é proposta para casais com infertilidade.