Treatment of Medication-Related Osteonecrosis of the Jaws without Segmental Resections: A Case Series.

BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious reaction to anti-resorptive drugs (ARDs) in patients treated for osteoporosis and conditions related to cancer. Treatment for MRONJ consists of the use of non-operative therapies according to the evolution of the disease, which consist of the use of antimicrobial mouthwashes, systemic antibiotics, and operative therapies, such as debridement of necrotic bone, marginal or segmental resection, and bone reconstruction of the jaws in more advanced stages of the disease. CASE REPORT This is a case series of 11 female patients treated for MRONJ, with a mean age of 76.5 years. Patients with malignant diseases of the jaws or those undergoing head and neck radiotherapy were excluded. Nine patients were medicated for osteoporosis with oral bisphosphonates and denosumab, and 2 patients used zoledronate to treat metastatic breast cancer. MRONJ prevailed in the mandible, most patients were classified as stage 2, and the most frequent triggers were tooth extraction and prosthetic trauma. All patients initially underwent non-operative therapies and were operated according to MRONJ stage, but none required segmental resection. Adjuvant treatments were used in 5 patients, and mean treatment and follow-up periods were 5 and 18.3 months, respectively. There was complete resolution of disease in all patients, with only 1 relapse. CONCLUSIONS This case series suggests that it is possible to treat MRONJ with conservative therapies in the early stages of the disease and minimally invasive surgeries in more advanced stages of the disease, thus avoiding segmental jaw resections.

A Case Report of Oral Bisphosphonate Treatment for Osteoporosis Leading to Atypical Femoral Fracture and Pathologic Mandibular Fracture.

BACKGROUND Bisphosphonates inhibit bone resorption in patients with postmenopausal osteoporosis and reduce osteoporotic fracture incidence. Medication-related osteonecrosis of the jaws (MRONJ) and atypical femoral fractures (AFF) are both rare but serious adverse effects of anti-resorptive drugs (ARD) such as bisphosphonates. The most advanced form of MRONJ is termed stage 3 and can lead to severe local sequelae like pathologic mandibular fractures (PMF). This study reports a case of MRONJ-related PMF and AFF with osteomyelitis secondary to bisphosphonate treatment for osteoporosis. CASE REPORT A 63-year-old white woman was diagnosed with PMF related to MRONJ stage 3 during treatment of an AFF with osteomyelitis. She had been treated for postmenopausal osteoporosis with 70 mg of alendronate weekly for 2 years. The PMF was treated by stable internal fixation combined with debridement and sequestrectomy, but further debridement was required and 2 mandibular implants were then removed. Postoperative recovery was uneventful and the mandibular infection was controlled after the second surgery. Three weeks later, she was discharged from the hospital, instructed to discontinue the use of alendronate, and referred for 30 sessions of hyperbaric oxygen therapy. At the 3-year follow-up, the PMF was completely healed without signs of mandibular infection or bone exposure. CONCLUSIONS This report raises awareness of both MRONJ and AFF as possible adverse effects of short-term bisphosphonate therapy for postmenopausal osteoporosis, and highlights the importance of dental and orthopedic follow-ups. It is crucial to emphasize the need for early diagnosis and treatment to prevent MRONJ progression to PMF.

Performance of panoramic radiography compared with computed tomography in the evaluation of pathological changes in the maxillary sinuses: a systematic review and meta-analysis.

OBJECTIVE: A systematic review was performed to evaluate the performance of panoramic radiography (PR) vs CT or cone beam CT (CBCT) in the diagnosis of pathological maxillary sinuses. METHODS: This review was registered in the PROSPERO database under the number CRD42020211766. Observational studies that compared PR with CT/CBCT were used to evaluate pathological changes in the maxillary sinuses. A complete search of seven primary databases and gray literature was carried out. The risk of bias was assessed according to the Newcastle-Ottawa tool, and the GRADE tool was used to assess the quality of evidence. A binary meta-analysis was performed to assess the effectiveness of evaluating pathological alterations in the maxillary sinuses in PR and CT/CBCT. RESULTS: Seven studies were included in our study, out of which four were included in a quantitative analysis. All studies were classified as low risk of bias. Five studies compared PR with CBCT and two studies compared PR to CT. The most common pathological alteration in maxillary sinuses reported was mucosal thickening. CT/CBCT was seen to be the most effective method for assessing pathological changes in the maxillary sinus when compared to PR (RR = 0.19, 95% confidence interval [CI] = 0.05 to 0.70, p = 0.01). CONCLUSION: CT/CBCT are the most appropriate imaging methods to evaluate pathological changes in the maxillary sinuses, while PR is still limited in the evaluation of these changes being considered only for initial diagnosis.

Prevalência de radiolucência justa-apical e sua relação com terceiros molares inferiores em radiografias panorâmicas / Prevalence of juxta-apical radiolucency and association/relations with the lower third molar in panoramic radiography

Objetivo: Avaliar a prevalência da radiolucência justa-apical (RJA) e sua relação com os terceiros molares inferiores, em 1054 radiografias panorâmicas. Métodos: A amostra foi constituída por radiografias panorâmicas digitais de indivíduos maiores de 18 anos, com pelo menos um terceiro molar inferior. As imagens foram analisadas para a presença de RJA em relação à corticalização, localização, relação com o canal mandibular, angulação e profundidade de impactação do terceiro molar. Os dados foram analisados através de estatística descritiva e pelo teste Qui-quadrado, sendo que valores de p < 0,05 foram considerados como significativos. Resultados:Foi encontrada uma prevalência de 2,75% de RJA, sendo predominante no sexo feminino (p = 0,01). A RJA foi visualizada em maior número corticalizada (58,63%), lateroapical (48,27%), em dentes parcialmente intraósseo (68,97%) e mesioangulados (55,17%). Em relação ao canal mandibular, houve maior prevalência na posição sobreposta ao canal mandibular (65,52%). Conclusão: A prevalência de RJA foi de 2,75% do total de 1054 radiografias panorâmicas avaliadas. Em relação ao canal mandibular, apresentou maior prevalência sobreposto. Além disso, a maior parte das RJA se apresentaram corticalizadas, em posição lateroapical, associada a dentes em posição mesioangular. Descritores: Radiografia panorâmica. Dente serotino. Nervo mandibular.Prevalência de radiolucência justa-apical e sua relação com terceiros molares inferiores em radiografias panorâmicas

Aim: To evaluate the prevalence of juxta-apical radiolucency (JAR) and its relationship with the lower third molars and adjacent structures, in 1,054 panoramic radiographs. Methods: The sample consisted of digital panoramic radiographs of individuals over 18 years of age, with at least one lower third molar. The images were analyzed for the presence of JAR in relation to corticalization, location, impaction depth, relationship with the mandibular canal, angulation, and impaction of the third molar. Data were analyzed using descriptive statistics and the chi-square test, and values of p < 0.05 were considered significant.Results: A prevalence of 2.75% of JAR was found, with a statistical difference between JAR and gender (p = 0.01), which proved to be predominant in females. The JAR was seen in greater numbers as corticalized (58.63%), lateroapical (48.27%), and mesioangulated (55.17%), as well as in erupted teeth (31.03%). In relation to the mandibular canal, it presented a higher prevalence when superimposed upon the mandibular canal (65.52%). Conclusions:The prevalence of RJA was 2.75% of the 1,054 evaluated panoramic radiographs. In relation to the mandibular canal, it presented a higher prevalence of superimposition. In addition, most of the RJA were corticalized, in a lateroapical position, associated with teeth in a mesioangular position. Uniterms: Panoramic radiography. Third molar. Mandibular nerve.

Absence of medication-related jaw osteonecrosis after treatment with strontium ranelate in ovariectomized rats.

This study aimed to evaluate the potential of strontium ranelate (SR) in medication-related jaw osteonecrosis (MRONJ) after tooth extraction in ovariectomized rats. Thirty ovariectomized rats were divided into three groups (n = 10): bisphophonate (BP) group (zoledronic acid; 0.4 mg/kg/week), SR group (625 mg/kg/day), and control group (saline solution). The lower first molars were extracted after 60 days of drug therapy. Drug administration was continued for another 30 days after tooth extraction. The mandibles were subjected to clinical, histological, radiographic, and microtomographic evaluations. Only the BP group showed clinical changes, characterized by the presence of 70% (n = 7) and 20% (n = 2) of ulcers and extraoral fistulas. Radiographic evaluation demonstrated bone sequestration only in the BP group (n = 7, 70%). Microtomographic analysis revealed increased bone porosity after ovariectomy, particularly in the the control group (p < 0.05). The BP group showed a higher bone surface density, bone volume, and trabecular number than SR and control groups, but with less trabecular separation (p < 0.05). All the animals in the BP group demonstrated histological osteonecrosis. There was no evidence of osteonecrosis in the control and SR groups, which was characterized by the absence of empty osteocyte gaps and associated with the gradual healing of the extraction area. Also, an increased number of blood vessels and a reduced number of osteoclasts were observed in the SR group (p < 0.05). Therefore, SR treatment increased angiogenesis and osteoclastogenesis in the healing socket and was not associated with MRONJ development after tooth extraction in ovariectomized rats.

Physical exercise attenuates obesity development in Western-diet fed obese rats independently of vitamin D supplementation.

Physical inactivity, associated with the ingestion of hypercaloric foods, contributes to obesity development. In contrast, physical exercise training (ET) can slow obesity progression. Vitamin (Vit) D, a hormone that regulates adipocyte metabolism, may represent a strategy to reduce obesity; however, it is currently not known whether Vit D enhances the anti-obesity benefits of physical exercise. We hypothesized that swimming ET may prevent Western diet (WD)-induced obesity, and that Vit D supplementation could enhance the anti-obesity actions of ET. Male Wistar rats were fed, from 21 to 90 days of age, on a standard diet, or a WD, in association or not (sedentary control [CTL-SED] and WD [WD-SED] groups) with swimming ET for 15 min/day, 3 days a week (exercised CTL [CTL-EXE] and WD [WD-EXE] groups). Additionally, at 60 days of age, half of the CTL-EXE and WD-EXE groups were submitted, or not, to oral Vit D supplementation (CTL-EXE-VD and WD-EXE-VD groups, respectively). At 91 days old, WD-SED rats displayed increased body weight, abdominal adiposity, hypercholesterolemia, hyperleptinaemia and high circulating levels of tumour necrosis factor (TNF)-α. Swimming ET attenuated the increase in abdominal adiposity induced by WD. Furthermore, the WD-EXE group exhibited reductions in glycaemia, triglyceridaemia, cholesterolaemia, leptinaemia and in plasma TNF-α concentrations. Vitamin D supplementation, combined with ET, did not provide any additive benefit against adiposity, only potentiating the effects of ET action on the reduction in triglyceridaemia. Exercise training, independently of Vit D, provides a strategy to attenuate the adiposity expansion that is induced by WD, mediated in part by reductions in leptinaemia and TNF-α levels.

Effect of pentoxifylline and α-tocopherol on medication-related osteonecrosis of the jaw in rats: Before and after dental extraction.

OBJECTIVE: Evaluate the effect of pentoxifylline and α-tocopherol administration in the prevention or treatment of medication-related jaw osteonecrosis (MRONJ). METHODOLOGY: Sixty Wistar rats were divided into three prevention (C-prev, BP-prev and BP/PT-prev) and three treatment groups (C-treat, BP-treat and BP/PT-treat), n = 10. The animals in the BP-prev, BP/PT-prev, BP-treat and BP/PT-treat groups received zoledronic acid (0.1 mg/kg) for 12 weeks, while the animals in the C-prev and C-treat groups received saline solution. At week 6, all animals underwent tooth extraction. Between week 5 and week 12, the BP/PT-prev group was treated with pentoxifylline (50 mg/kg/day) and α-tocopherol (80 mg/kg/day), with euthanasia at the end of week 12. The BP/PT-treat group received the same drug protocol, but it was performed between week 12 and week 16, with euthanasia at the end of week 16. Afterwards, the presence of osteonecrosis was evaluated by clinical analysis, radiographic and histological. RESULTS: BP/PT-treat group showed a reduction in the histological incidence of osteonecrosis by 50%, decrease the percentage of empty osteocyte gaps and the necrotic area, decrease the presence of bone sequestration and increase the number of osteocytes and alveolar blood flow (p < 0.05). However, BP/PT-prev group showed only a reduction in the necrotic area percentage when compared to BP-prev (p < 0.05). CONCLUSIONS: Pentoxifylline and α-tocopherol administration before tooth extraction was not effective in preventing MRONJ. However, this drug protocol was able to reduce MRONJ manifestation when administrate after discontinuation of bisphosphonate, thus it can be considered as a viable strategy for the treatment of this pathological condition.

Absence of medication-related jaw osteonecrosis after treatment with strontium ranelate in ovariectomized rats

Abstract This study aimed to evaluate the potential of strontium ranelate (SR) in medication-related jaw osteonecrosis (MRONJ) after tooth extraction in ovariectomized rats. Thirty ovariectomized rats were divided into three groups (n = 10): bisphophonate (BP) group (zoledronic acid; 0.4 mg/kg/week), SR group (625 mg/kg/day), and control group (saline solution). The lower first molars were extracted after 60 days of drug therapy. Drug administration was continued for another 30 days after tooth extraction. The mandibles were subjected to clinical, histological, radiographic, and microtomographic evaluations. Only the BP group showed clinical changes, characterized by the presence of 70% (n = 7) and 20% (n = 2) of ulcers and extraoral fistulas. Radiographic evaluation demonstrated bone sequestration only in the BP group (n = 7, 70%). Microtomographic analysis revealed increased bone porosity after ovariectomy, particularly in the the control group (p < 0.05). The BP group showed a higher bone surface density, bone volume, and trabecular number than SR and control groups, but with less trabecular separation (p < 0.05). All the animals in the BP group demonstrated histological osteonecrosis. There was no evidence of osteonecrosis in the control and SR groups, which was characterized by the absence of empty osteocyte gaps and associated with the gradual healing of the extraction area. Also, an increased number of blood vessels and a reduced number of osteoclasts were observed in the SR group (p < 0.05). Therefore, SR treatment increased angiogenesis and osteoclastogenesis in the healing socket and was not associated with MRONJ development after tooth extraction in ovariectomized rats.

Vitamin D supplementation decreases visceral adiposity and normalizes leptinemia and circulating TNF-α levels in western diet-fed obese rats.

AIMS: Vitamin (Vit) D regulates various organic processes, including adipose tissue morphofunction and lipid metabolism. Studies indicate that Vit D bioavailability is reduced in obesity, which could contribute to obesity development; however, the effects of Vit D supplementation on increased adiposity in western diet (WD)-obese rats (an experimental model that better resembles the obesogenic human obesity condition) have not been studied, to date. Thus, we hypothesized that Vit D supplementation following the induction of obesity in WD rats might reduce their body weight (BW) and adiposity. MAIN METHODS: Male Wistar rats were fed on a standard chow [control (CTL) group] or a WD to induce obesity (WD group), from 21 to 59 days of age. Subsequently, from 60 to 90-days, half of the CTL and of the WD rats were randomly submitted, or not, to oral Vit D supplementation (CTL-VD and WD-VD groups, respectively). KEY FINDINGS: At 91 days of age, WD rats were obese, displaying higher abdominal circumference and white fat stores, dyslipidemia, hyperleptinemia and greater plasma levels of tumor necrosis factor (TNF)-α. Vit D supplementation decreased BW gain, abdominal fat deposition and ameliorated the plasma lipid profile in WD-VD rats. These effects were accompanied by reductions in leptinemia and in circulating TNF-α levels in these rodents. SIGNIFICANCE: Vit D supplementation, following the induction of obesity, may represent a good strategy to attenuate BW gain and abdominal adiposity, and ameliorate the plasma lipid profile in WD rats. These effects may be mediated, at least in part, by reductions in circulating levels of leptin and TNF-α.

Efeito da clorexidina em microrganismos na saliva de doentes internados em unidade de terapia intensiva / Effects of chlorhexidine on the salivary microorganisms of patients in intensive care units / Efecto de la clorhexidina en los microorganismos de la saliva de pacientes ingresados en una unidad de cuidados intensivos

Resumo Enquadramento: O controlo do biofilme oral com anti-sépticos deve ser adequado aos protocolos elaborados para os doentes na unidade de terapia intensiva (UTI). Objetivo: Avaliar o efeito da solução de clorexidina 0,12% na redução de microrganismos na saliva de doentes de UTI. Metodologia: Estudo coorte com 45 voluntários divididos em: Clínica Médica (controlo, auto higiene oral), UTI não-entubado e UTI entubado. A higiene oral na UTI foi realizada com clorexidina. A análise microbiológica foi realizada com a contagem de microrganismos na saliva. A análise dos dados foi feita com ANOVA. Resultados: Houve uma redução dos microrganismos após higiene oral. O controlo apresentou diferença significativa com UTI entubado nos períodos imediato e após 30 min. Doentes entubados apresentaram redução dos microrganismos até 12 horas após higiene com clorexidina. Conclusão: A higiene com clorexidina reduz em até 12 horas os microrganismos bucais de doentes entubados. Estes resultados podem contribuir para elaboração de protocolos de higiene oral em UTI, além de sustentar estratégias como redução nos custos e efeitos colaterais associados à clorexidina.

Abstract Background: The control of oral biofilm with antiseptics should follow the protocols designed for patients in intensive care units (ICUs). Objective: To assess the effects of using 0.12% chlorhexidine solution in reducing the number of microorganisms in the saliva of ICU patients. Methodology: Cohort study with 45 volunteers divided into Medical Clinic (control group, oral self-care), non-intubated ICU, and intubated ICU. Oral hygiene in the ICU was performed with chlorhexidine. Microbiological analysis was performed through salivary bacterial count. Data were analyzed using ANOVA. Results: The number of microorganisms decreased after oral hygiene. A significant difference was found between the control and the ICU intubated groups in the immediate period and after 30 minutes. The number of microorganisms in intubated patients decreased 12 hours after oral hygiene with chlorhexidine. Conclusion: The number of oral microorganisms decreases in intubated patients 12 hours after oral hygiene with chlorhexidine. These results may contribute to elaborating oral hygiene protocols for ICUs and planning strategies, for example, to reduce the costs and the side effects associated with chlorhexidine use.

Resumen Marco contextual: El control de la biopelícula oral con antisépticos debe ser adecuado a los protocolos elaborados para los pacientes de una unidad de cuidados intensivos (UCI). Objetivo: Evaluar el efecto de la solución de clorhexidina al 0,12% en la reducción de los microorganismos en la saliva de los pacientes en una UCI. Metodología: Estudio de cohorte con 45 voluntarios divididos en Clínica Médica (control, autohigiene bucal), UCI no intubados y UCI intubados. La higiene bucal en la UCI se realizó con clorhexidina. El análisis microbiológico se realizó con el recuento de microorganismos en la saliva. El análisis de los datos se realizó con ANOVA. Resultados: Hubo una reducción de los microorganismos después de la higiene bucal. El control mostró una diferencia significativa con los pacientes intubados en la UCI en el momento y después de 30 minutos. Los pacientes intubados mostraron una reducción de los microorganismos hasta 12 horas después de la higiene con clorhexidina. Conclusión: La higiene con clorhexidina reduce en un máximo de 12 horas los microorganismos bucales en pacientes intubados. Estos resultados pueden contribuir a la elaboración de protocolos de higiene bucal en las UCI, además de apoyar estrategias como la reducción de costes y los efectos secundarios asociados a la clorhexidina.

Effects of low-dose aspirin on the osseointegration process in rats.

BACKGROUND: Several drugs are capable of promoting changes in bone metabolism. The aim of this study was to evaluate the effect of long-term low-dose aspirin (LDA) therapy on implant osseointegration. METHODS: Male Wistar rats were divided into 4 groups (n = 8/group) according to oral gavage solution received prior (42 days) to the implant surgery on the tibia. The control group was treated with saline solution for 7 (CG-7) and 28 (CG-28) days. The use of low-dose aspirin was performed in AG groups (6.75 mg/kg of aspirin) for 7 (AG-7) and 28 (AG-28) days. After experimental periods, histomorphometric evaluation of bone-to-implant contact (BIC) and the bone area between threads (BABT) was performed. RESULTS: Reduced BIC values were detected in AG-7 (62.8% ± 17.1) group compared to AG-28 (91.9% ± 5.4), CG-7 (82.7% ± 15.2), and CG-28 (89.9% ± 9.7). BABT evaluation revealed lower values in AG-7 (70.9% ± 15.2) compared to AG-28 (95.4% ± 3.7) and CG-28 (87.1% ± 10.2) groups. CONCLUSIONS: The treatment with low doses of aspirin promoted a discrete inhibitory effect in the early stages (7 days) of repair after implant placement, specifically in the bone deposition. However, these effects were not detected in the late stages (28 days), considering BIC and BABT parameters.

Caloric restriction prevents alveolar bone loss in the experimental periodontitis in obese rats.

AIMS: It has been shown that periodontitis, can be modified by systemic changes, including behavioral factors, such as diet. Caloric restriction is one of the dietary therapeutic strategies indicated for obesity. It is associated with several benefits, among them, modulation of the inflammatory response. The aim of this study was to verify whether caloric restriction in obese rats changes the progression of experimental ligature-induced periodontitis. MATERIALS AND METHODS: Forty-eight Wistar rats were used for 24 weeks and initially fed with cafeteria diet during 12 weeks. The animals were divided into four groups according to the caloric restriction and experimental periodontitis. The cotton thread was placed around the mandibular first molars, for 15 days, before the end of the experiment. Rats submitted to caloric restriction received, from the 13th week of the experimental protocol, 70% of the food intake compared to the ad libitum animals of other study of the our research group. Alveolar bone loss was assessed using macroscopic morphometric analysis. Analyzes of clinical periodontal measures, biometrics, serum biomarkers and biochemical parameters were performed. KEY FINDINGS: Caloric restriction decreased the alveolar bone loss in the periodontitis group when compared to the group that received a cafeteria diet with periodontitis. Moreover, the results demonstrate the improvement in the glycemic profile, without prejudice to bone tissue biomarkers. SIGNIFICANCE: Based on the results, caloric restriction reduces the progression of alveolar bone loss in rats with experimental periodontitis, in addition to presenting benefits in biometric data, decreasing both glycemic profile and clinical periodontal measures.

Cervical spine range of motion, posture and electromyographic activity of masticatory muscles in temporomandibular disorders / Amplitude de movimento articular cervical, postura e atividade eletromiográfica da musculatura mastigatória na disfunção temporomandibular / Rango del movimiento articular de la columna cervical, postura y actividad electromiográfica de la musculatura masticatoria en la disfunción temporomandibular

Abstract Introduction: Temporomandibular joint disorders (TMD or TMJD) involve clinical problems and symptoms affecting the temporomandibular joint (TMJ) and associated structures. The temporomandibular joints are anatomically connected to the cervical region, where cervical spine movements occur simultaneously to masticatory muscle activation and jaw movements. Objective: Our study sought to assess the relationship between the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), surface electromyography (sEMG) of the masticatory muscles, posture and cervical flexibility in women with TMD. Method: Fifty women with an average age of 27.0 ± 6.37 years, diagnosed with TMD according to RDC/TMD, were assessed for craniocervical posture, cervical flexibility and sEMG of the masticatory muscles. Results: There were no differences in jaw function limitations, depression, pain level and its interference in work ability and daily activities, posture and sEMG between TMD diagnoses or between muscle classification (p > 0.05). Depression scores were higher among participants with biarticular dysfunction (p = 0.023). The group with bruxism exhibited a higher pain level at assessment (p = 0.001) and a greater reduction in work ability (p = 0.039). Subjects with muscular and mixed TMD showed less cervical rotation to the right when compared with those with articular TMD. Conclusion: There was no difference in posture or sEMG values for TMD diagnoses, joint and muscle dysfunctions and the presence of bruxism. Muscle dysfunction is associated with reduced cervical rotation to the right. Jaw function limitations did not interfere in posture or sEMG and depression was associated with pain.

Resumo Introdução: A disfunção temporomandibular (DTM) compreende alterações clínicas e sintomas que envolvem a articulação temporomandibular (ATM) e estruturas associadas. A ATM possui conexões anatômicas com a região cervical, onde os movimentos das vértebras cervicais ocorrem simultaneamente com a ativação dos músculos mastigatórios e dos movimentos da mandíbula. Objetivo: O objetivo foi verificar a relação entre achados do Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) com a eletromiografia de superfície (EMGs) da musculatura mastigatória, postura e flexibilidade cervical em mulheres com DTM. Método: Cinquenta mulheres com DTM, pelo RDC/TMD, com idade média de 27,0 ± 6,37 anos foram avaliadas quanto à postura craniocervical, flexibilidade cervical e EMGs da musculatura mastigatória. Resultados: Não houve diferença quanto às limitações relacionadas à função mandibular (LRFM), depressão, grau de dor e interferência no trabalho e atividades diárias, postura e EMGs entre os diagnósticos de DTM e entre a classificação muscular (p > 0,05). O comprometimento biarticular apresentou maior depressão (p = 0,023). O grupo com bruxismo apresentou maior grau de dor no momento (p = 0,001), e maior comprometimento na capacidade de trabalhar (p = 0,039). A DTM muscular e mista tiveram menor rotação à direita em comparação ao diagnóstico articular. Conclusão: Os diagnósticos de DTM, os variados comprometimentos articulares e musculares e a presença de bruxismo não apresentaram diferença quanto à postura e a EMGs. O comprometimento muscular está associado a uma menor rotação cervical à direita. As LRFM não interferiram na postura e na EMGs. A depressão tem associação com a dor.

Resumen Introducción: La disfunción temporomandibular (DTM) incluye alteraciones clínicas y síntomas que involucran la articulación temporomandibular (ATM) y estructuras asociadas. La ATM posee conexiones anatómicas con la región cervical donde los movimientos de las vértebras cervicales ocurren simultáneamente con la activación de los músculos masticatorios y de los movimientos de la mandíbula. Objetivo: Verificar la relación entre la presencia de hallazgos de Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) con la electromiografía superficial (EMG) de la musculatura masticatoria, postura y flexibilidad cervical en mujeres con DTM. Método: Cincuenta mujeres con DTM, por el RDC/TMD, con edad promedio de 27,0 ± 6,37 años fueron evaluadas en cuanto a la postura craniocervical, flexibilidad cervical y EMG de la musculatura masticatoria. Resultados: No hubo diferencia en las limitaciones relacionadas con la función mandibular (LRFM), depresión, grado de dolor e interferencia en el trabajo y actividades diarias, postura y EMG entre los diagnósticos de DTM y entre la clasificación muscular (p > 0,05). La disfunción biarticular presentó mayores puntuaciones de depresión (p = 0,023). El grupo con bruxismo presentó mayor grado de dolor (p = 0,001), y mayor reducción en la capacidad de trabajo (p = 0,039). La DTM muscular y mixta tuvieron menor rotación a la derecha en comparación con el diagnóstico articular. Conclusión: Los diagnósticos de DTM con los variados comprometimientos articulares y musculares y la presencia de bruxismo no presentaron diferencias en cuanto a la postura y la EMG. El comprometimiento muscular está asociado a una menor rotación a la derecha de la cervical. Las LRFM no interfirieron en la postura y la EMG, y la depresión estuvo asociada con el dolor.

Association Between Exercise and Treatment with Liraglutide in Obese Rats by Cafeteria Diet

Abstract The objective of this study was to evaluate the effect of liraglutide, an analog of glucagon-like peptide-1 (GLP-1) in association with physical exercise, on the metabolic and biochemical parameters of rats induced to obesity with a cafeteria diet. Male Wistar rats, aged 21 days, were randomly divided into: Controls (CON) receiving standard feed and water ad libitum; and obese (OBESE) receiving cafeteria diet ad libitum, added to the standard diet. Groups were then subdivided into: Liraglutide animals that received subcutaneous injections of liraglutide from 80 to 90 days of life; exercised (EXE) animals submitted to swimming sessions, three days a week (15 min); and liraglutide + EXE animals that received liraglutide in association with physical exercise. Treatment with liraglutide reduced deposits of mesenteric and periepididymal fat, HOMA-IR, triglycerides, glucose and insulin in obese group. It is important to note that the association of the two treatments reduced the body weight in animals, deposits of mesenteric and periepididymal fat, HOMA-IR, blood triglyceride levels, glucose and insulin in obese rats. As such, the association of liraglutide with exercise potentiated the effects of the drug and ameliorated obesity pathology more effectively. retirar

Prevalência de calcificação de placa ateromatosa em carótida por meio da radiografia panorâmica / Prevalence of carotid artery calcifications on panoramic radiographs

Objetivo: Avaliar a prevalência de calcificação de placa ateromatosa (PAC) na região de bifurcação da carótida em radiografias panorâmicas realizadas em uma população brasileira. Métodos: Nesse estudo realizou-se a avaliação da prevalência de imagem sugestiva de PAC em 450 radiografias panorâmicas de pacientes atendidos no período entre 2015 e 2017. As radiografias foram analisadas para a presença de PAC. Resultados: Dezesseis pacientes (3,55%) apresentaram imagens sugestivas de PAC. A maior prevalência foi no gênero feminino (4,5%), a faixa etária mais prevalente foi entre 61 e 80 anos (12,2%) e a localização mais frequente foi unilateral (81,2%). Conclusão: A presença de PAC na região de bifurcação da carótida foi encontrada em 3,55% dos pacientes, sendo mais prevalentes em mulheres leucodermas, acima de 60 anos e unilateral.

Aim: To evaluate the prevalence of calcified atheromatous plaque (CAP) in the region of carotid bifurcation in panoramic radiographs in a Brazilian population. Methods: This study evaluated the prevalence of images suggestive of CAP in 450 panoramic radiographs of patients in the period between 2015 and 2017. Results: Sixteen patients (3.55%) presented images that were suggestive of CAP. The highest prevalence was in the female sex (4.5%), the most prevalent age group was between 61 and 80 years old (12.2%), and the most frequent location was unilateral (81.2%). Conclusion: The presence of CAP in the region of carotid bifurcation was found in 3.55% of the patients, and proved to be more prevalent in white women over 60 years of age and unilateral.

Agreement, correlation, and kinetics of the alveolar bone-loss measurement methodologies in a ligature-induced periodontitis animal model.

Periodontal research involves the use of animal models to better understand the biological processes of periodontal diseases and the potential of new or existing therapies. Currently, ligature-induced periodontitis in rats is the main model used in periodontal research, in this model, alveolar bone loss (ABL) is the main parameter evaluated by radiographic, morphometric, and histological techniques. Interestingly, although these methodologies are widely used, it is not totally clarified neither the kinetics of ABL over the induction time nor the agreement degree (repeatability and reproducibility) of these techniques. OBJECTIVE: To characterize ABL kinetics at 0, 3, 7, 15, 30, and 60 days after ABL induction by ligature and to evaluate the intra- (repeatability) and inter-examiner (reproducibility) agreement and the correlation among the radiographic, morphometric, and histological methodologies. MATERIAL AND METHODS: 60 male Wistar rats with induced ABL were randomly divided into 6 experimental groups (n = 10 animals/group). After 0, 3, 7, 15, 30, and 60 days, the animals were euthanized and their hemimandibles were removed for ABL determination using radiographic, morphometric and histological techniques. RESULTS: Radiographic and morphometric/linear techniques allowed the detection of statistically significant ABL on the third day, while histological and morphometric/area techniques could only detect ABL after the seventh day (ANOVA/Tukey, p<0.05). After the fifteenth day, except for histological analysis, the ABL was stabilized. Concerning the agreement of the methodologies, Bland Altman's test (intra and inter-examiner evaluations) showed no difference among the measurements (p>0.05). In addition, high correlations (Pearson's test, r2>0.9, p<0.05) were observed. CONCLUSION: The results indicated that the minimum time for ABL induction could vary from 3 to 7 days, according to the chosen analysis methodology. Agreement and correlation data support the comparison of results between studies with same induction time.

Agreement, correlation, and kinetics of the alveolar bone-loss measurement methodologies in a ligature-induced periodontitis animal model

Abstract Periodontal research involves the use of animal models to better understand the biological processes of periodontal diseases and the potential of new or existing therapies. Currently, ligature-induced periodontitis in rats is the main model used in periodontal research, in this model, alveolar bone loss (ABL) is the main parameter evaluated by radiographic, morphometric, and histological techniques. Interestingly, although these methodologies are widely used, it is not totally clarified neither the kinetics of ABL over the induction time nor the agreement degree (repeatability and reproducibility) of these techniques. Objective: To characterize ABL kinetics at 0, 3, 7, 15, 30, and 60 days after ABL induction by ligature and to evaluate the intra- (repeatability) and inter-examiner (reproducibility) agreement and the correlation among the radiographic, morphometric, and histological methodologies. Material and Methods: 60 male Wistar rats with induced ABL were randomly divided into 6 experimental groups (n = 10 animals/group). After 0, 3, 7, 15, 30, and 60 days, the animals were euthanized and their hemimandibles were removed for ABL determination using radiographic, morphometric and histological techniques. Results: Radiographic and morphometric/linear techniques allowed the detection of statistically significant ABL on the third day, while histological and morphometric/area techniques could only detect ABL after the seventh day (ANOVA/Tukey, p<0.05). After the fifteenth day, except for histological analysis, the ABL was stabilized. Concerning the agreement of the methodologies, Bland Altman's test (intra and inter-examiner evaluations) showed no difference among the measurements (p>0.05). In addition, high correlations (Pearson's test, r2>0.9, p<0.05) were observed. Conclusion: The results indicated that the minimum time for ABL induction could vary from 3 to 7 days, according to the chosen analysis methodology. Agreement and correlation data support the comparison of results between studies with same induction time.

Effects of Cinnamoyloxy-mammeisin from Geopropolis on Osteoclast Differentiation and Porphyromonas gingivalis-Induced Periodontitis.

Bone-loss-related diseases such as rheumatoid arthritis, osteomyelitis, osteoporosis, and periodontitis are associated with high rates of morbidity worldwide. These disorders are characterized by an imbalance between the formation and activity of osteoblasts and osteoclasts, leading to bone loss. In this context, we evaluated the effect of cinnamoyloxy-mammeisin (CNM), an anti-inflammatory coumarin found in Melipona scutellaris geopropolis, on key targets related to bone remodeling. In the present study we investigated the in vitro effects of CNM on osteoclast differentiation and M-CSF+RANKL-induced osteoclastogenic marker expression. Additionally, the interference of CNM treatment on osteoclast activity was evaluated by zymography and resorption area. Finally, we assessed the capacity of the compound to mitigate alveolar bone loss in vivo in experimental murine periodontitis induced by Porphyromonas gingivalis. We observed that treatment with CNM impaired osteoclast differentiation, as evidenced by a reduced number of tartrate-resistant acid-phosphatase-positive multinucleated cells (TRAP+) as well as the expression of osteoclastogenic markers upon M-CSF+RANKL-induced stimulation. Similarly, we observed reduced gelatinolytic and resorption capacity in M-CSF+RANKL-induced cells in vitro. Lastly, CNM attenuated alveolar bone loss in an experimental murine periodontitis model. These findings indicate that CNM may be considered a promising treatment for bone loss diseases.