Proteomic analysis of salivary inflammatory biomarkers of developmental gingival enlargements in patients with West and Noonan syndromes: a preliminary pilot single-center retrospective study.

OBJECTIVE: The aim of the preliminary pilot single-center retrospective cross-sectional study was to analyze and compare the presence of non-secretory salivary inflammatory biomarkers in pediatric patients with West syndrome, Noonan syndrome, and a healthy control group. PATIENTS AND METHODS: A total of 60 saliva samples were collected during dental check-ups. The saliva samples collected were analyzed by liquid chromatography. The results were analyzed with a t-test, and the statistical significance was given by a p-value lower than 0.05. RESULTS: We found statistical significance for defensin α1 (p=0.006) and thymosin ß4 (p=0.025) in the Noonan syndrome. In the West syndrome, only the defensin α1 had a statistically significant difference with the other groups (p=0.022). Proteomic analysis revealed an overexpression of peptides related to the innate (thymosin ß4) and acquired (defensin α1, α3) immunity. CONCLUSIONS: West and Noonan's syndromes showed the overexpression of molecular biomarkers involved in the pathogenesis of chronic periodontitis. The inflammatory status is triggered and amplified by the abnormal overgrowth of gingival tissues, the amplified release of proinflammatory cytokines from the immune cells, and the poor cooperation in maintaining adequate oral hygiene.

Three-dimensional stereophotogrammetric analysis of nasolabial soft tissue effects of rapid maxillary expansion: a systematic review of clinical trials.

The aim of this systematic review is to analyse the quality and clinical evidence in the literature analysing, through 3D stereophotogrammetry, the nasolabial soft tissue modifications that may occur after rapid maxillary expansion (RME). This systematic literature review was based on the PRISMA-P statement and was registered in the PROSPERO database with the following protocol ID: CRD42017079875. Pubmed, Cochrane, EBSCO, Scopus, Web of Science databases were searched with no restriction of year or publication status. Selection criteria were: randomised clinical trials, controlled clinical trials, cohort studies, cross-sectional studies, case-control studies on patients with unilateral/bilateral crossbite, transverse maxillary deficiency and crowding, treated with RME and monitored by 3D stereophotogrammetry. 652 articles were retrieved in the initial search. After the review process, 11 full-text articles met inclusion criteria. After the evaluation process, 4 publications were included for the present literature review. Due to the heterogeneous methodology meta-analysis was not possible; consequently, a systematic assessment of the studies and summary of the findings from the available evidence were used to answer the research question. The maximum widening of the alar cartilage is 1.41 ± 0.95 mm, whose clinical significance is open to question. The effect of RME on the mouth width remains controversial. In Altindis et al., the difference between pre-treatment and post-treatment mouth width (1.80 mm increment in the banded RME group) was statistically significant, while in Baysal 1.86 mm was considered a non-significant value. Inconsistencies and limitations in the study population and measurement protocols were detected between studies. These data underline the necessity for updated guidelines that allow to standardise, for this type of study, sample selection, measurement methods and collection of results.

Relationship between oral microbiota and periodontal disease: a systematic review.

OBJECTIVE: In recent years metagenomic analysis has become more accessible for the characterization of biological specimens. There has been an important increase of studies using this technique for subgingival human samples. To date, there are no updated systematic reviews on the relationship between oral microbiota and periodontal disease. The aim of the present systematic review was to update data about studies concerning the influences of changes in oral microbiota composition on the periodontal status in human subjects. MATERIALS AND METHODS: An electronic search was conducted in four databases (MEDLINE, Scopus, CENTRAL and Web of Science) for articles published in English from January 2014 to April 2018. In vitro or animal studies, case reports, case series, retrospective studies, review articles, abstracts and discussions were excluded. Also, studies that evaluated less than 5 microbial species, only viruses or already known periodontal pathogens were excluded. Two independent researches selected the studies and extracted the data. The quality of evidence was assessed as high, moderate or low for each microorganism. RESULTS: Eight studies and three additional publications recovered from the bibliography search of the selected articles were included in the review. The Bacteria domain was the main detected among the others and it included 53 species. The review confirmed the presence of recognized periodontal pathogens such as the members of the red complex but also identified, with high weight of evidence, the presence of new pathogens. CONCLUSIONS: The results of this systematic review support high evidence for the association of 3 new species/genera with the etiology of periodontitis. Future investigations on the actual role of these new pathogens in the onset and progression of the disease are needed.

Dental anaesthesia for children - effects of a computer-controlled delivery system on pain and heart rate: a randomised clinical trial.

Local anaesthesia in dentistry is usually given by conventional injection through a syringe. In this randomised, single-blind, split-mouth clinical study we evaluated the perception of pain and changes in heart rate in children being given dental local anaesthesia using a computer-controlled device compared with that given using a traditional syringe. Participants were in good general health with no contraindications to local anaesthetics. One half of each maxilla was anaesthetised using each technique, the order having been randomly selected according to a computer-generated sequence. The hypothesis was that the controlled anaesthetic flow rate results in virtually imperceptible injections. The outcomes were the perception of pain and the heart rate. Seventy-six children aged from 5-12 years old participated in this study. The mean (SD) pain score of the conventional injection was 5.51 (2.46) and the mean (SD) heart rate was 2.72 (6.76), which were significantly higher than those of the computerised delivery system, which were 4.74 (2.8) and 0.34 (7.3) (p=0.04). More patients anaesthetised with the traditional syringe technique required a second injection (n=21). These results suggest that dental anaesthesia given to children with a computer-controlled delivery system reduced pain better than that given with a conventional syringe.

Ossifying epulis in pseudohypo-parathyroidism: a case-based therapeutic approach.

BACKGROUND: The term Pseudohypoparathiroidism indicates a group of rare conditions characterised by end-organ resistance to the action of parathyroid hormone (PTH). Ossifying epulis (OE) is a exophytic gingival lesion characterised by spontaneous bone formation beneath the mucosa, which may affect children and adults: the exophytic, calcified outgrowths can occur in any bone and generally have favorable prognosis. Drug therapy may normalise calcium serum levels, but not completely avoid the occurrence of peripheral ossifying epulis. CASE REPORT: We report a representative case of a peripheral ossifying epulis in the mouth of a patient following a drug treatment protocol for her pseudohypoparathyroidism and to optimise serum markers. An 11-year-old girl was referred to our department, showing a bulky neoformation on the gingival margin of 0.6 mm diameter with sharp margins. The mass was completely excised. Histological analysis revealed distinctive features of a chronic and acute inflammatory microenvironment with plasma cells (positivity for CD38, MUM1, Lambda and Kappa chains) and bone tissue fragments with remodeling aspects referable to flogistic osteolysis. The biopsy result leads to hypothese a change in the patient's drug therapy. Multidisciplinary screening and individualised pharmacological treatment are strongly recommended in the clinical practice in order to improve the therapeutic results.

Risks in surgery-first orthognathic approach: complications of segmental osteotomies of the jaws. A systematic review.

OBJECTIVE: To date, no systematic review has been undertaken to identify the complications of segmental osteotomies. The aim of the present systematic review was to analyze the type and incidence of complications of segmental osteotomies, as well as the time of subjective and/or clinical onset of the intra- and post-operative problems. MATERIALS AND METHODS: A search was conducted in two electronic databases (MEDLINE - Pubmed database and Scopus) for articles published in English between 1 January 2000 and 30 August 2015; only human studies were selected. Case report studies were excluded. Two independent researchers selected the studies and extracted the data. Two studies were selected, four additional publications were recovered from the bibliography search of the selected articles, and one additional article was added through a manual search. RESULTS: The results of this systematic review demonstrate a relatively low rate of complications in segmental osteotomies, suggesting this surgical approach is safe and reliable in routine orthognathic surgery. CONCLUSIONS: Due to the small number of studies included in this systematic review, the rate of complication related to surgery first approach may be slightly higher than those associated with traditional orthognathic surgery, since the rate of complications of segmental osteotomies must be added to the complication rate of basal osteotomies. A surgery-first approach could be considered riskier than a traditional one, but further studies that include a greater number of subjects should be conducted to confirm these findings.

Unilateral lesions of the pedunculopontine nucleus do not alleviate subthalamic nucleus-mediated anticipatory responding in a delayed sensorimotor task in the rat.

Lesions of the subthalamic nucleus (STN) in the rat are known to cause anticipated movements in behavioral tasks requiring a preparatory period before the execution of externally cued conditioned movements. In the present study, we describe the effects of lesions of the pedunculopontine nucleus (PPN), a structure located on the outflow of the STN to lower brainstem and spinal motor nuclei, on the anticipatory responding caused by a unilateral lesion of the STN in a delayed sensorimotor task. Rats were instructed to keep a lever pressed down by the presentation of a composite visual and acoustic signal, and were required to hold the lever pressed until a trigger stimulus occurred after an unpredictable delay. The trigger stimulus required the animals to release the lever and to press a second lever for food reinforcement. The task was evaluated according to analysis of movement parameters and errors made by the animals during the preparative and executive phases of the conditioned movement. An ibotenate lesion was placed into the STN in either side of the brain. This lesion was followed 3 weeks later by an ibotenate lesion of the PPN ipsilaterally to the STN previously lesioned. The results indicate that the anticipatory responding induced by the STN lesion was not alleviated by the subsequent PPN lesion. However, the animals bearing the combined lesion were severely impaired in conditioned responding to salient stimuli involved in the paradigm and showed side-specific lengthening of reaction and movement times without global motor impairments. The results suggest that the anticipatory responses caused by STN lesions do not require the intervention of the PPN and that the disruption of the dopaminergic nigrostriatal pathway following the combined lesion may be responsible for impairments observed.