Combination of plant phenolics and isoquinolinium alkaloids protects gingival fibroblast and improves post-extraction healing after lower third molar extraction.

AIMS: The effect of polyphenolic fraction of Lonicera caerulea (PFLC) and alkaloid fraction of Macleaya cordata (AFMC) mix on the production of inflammatory mediators in human gingival fibroblasts pretreated with lipopolysaccharide (LPS) was investigated. In addition, protective effects of mucoadhesive paste containing combination of PFLC and AFMC (0.05% and 0.01%, respectively; n=15, Group A) and placebo (n=15, Group B) were evaluated in patients after surgical extraction of lower third molars. METHODS: Gingival fibroblasts were pre-treated with LPS (10 µg/mL; 24 h) and PFLC/AFMC (25/0.25; 50/0.25; 100/0.25; 25/0.5; 50/0.5; 100/0.5 µg/mL) in serum-free medium was applied for 4 h. Then the interleukin-6 (IL-6), reactive oxygen species (ROS) generation, level of intracellular glutathione (GSH) and expression of cyclooxygenase-2 (COX-2) were evaluated. The study was a 6-day, single-center, randomized, double-blind and placebo-controlled trial consisting of two parallel treatment arms. A modified Oral health impact profile questionnaire including both general oral condition and extraction related questions, was used to evaluate the oral condition and other changes before (day 0) and on the days 1, 3 and 6 after surgical extraction. RESULTS AND CONCLUSION: The combination of PFLC with AFMC caused a reduction of ROS generation, reduced IL-6 production and suppressed the expression of COX-2. In group A the paste treatment contributed to improvement of oral health-related quality of life. Topical application of PFLC and AFMC into the extraction wound improved post-extraction site wound healing probably by antioxidant and anti-inflammatory mechanisms.

Gene Expression of Vascular Endothelial Growth Factor A and its Receptors in Dental Pulp of Immature and Mature Teeth.

OBJECTIVE: Vascular endothelial growth factor A (VEGFA) and its receptors are essential proteins for the angiogenic activity of dental pulp. Angiogenesis fundamentally provides oxygen and nutrients to cells for root formation and defence mechanisms. The angiogenic potential of dental pulp should be understood and considered for the conservative and regenerative endodontics. The purpose of this research was to measure the VEGFA expression and its receptors such as vascular endothelial growth factor receptors 1, -2 (VEGFR1, VEGFR2) and Neuropilin 1 (NRP1) in human dental pulp from molars with immature and mature apexes. METHODS: VEGFA system mRNAs expressions were assessed in dental pulp obtained from freshly extracted human third molars divided into immature (n=8) and mature (n=8) apexes. RNAs were extracted from the samples. Each sample's cDNA was synthetized and the target genes VEGFA, VEGFR1, VEGFR2, NRP1 expression profiles obtained by RT2-PCR. Analysis was based on the Student's t-test comparing the replicate 2-ΔCt values for each gene. P values of <0.05 were considered significant. RESULTS: In teeth with mature apexes, VEGFA (P=0.0002), NRP1 (P=0.0001), VEGFR1 (P=0.0057) and VEGFR2 (P=0.018259) significantly increased statistically with respect to the immature apexes group. CONCLUSION: Within the limitation of the present investigation, it can be concluded that the angiogenic process seems to be a physiological process in the dental pulp due to the studied angiogenic growth factor are expressed in both immature and mature dental pulps. VEGFA and its receptors are expressed significantly higher in mature apex teeth than immature apex teeth.

The hidden structure of human enamel.

Enamel is the hardest and most resilient tissue in the human body. Enamel includes morphologically aligned, parallel, ∼50 nm wide, microns-long nanocrystals, bundled either into 5-µm-wide rods or their space-filling interrod. The orientation of enamel crystals, however, is poorly understood. Here we show that the crystalline c-axes are homogenously oriented in interrod crystals across most of the enamel layer thickness. Within each rod crystals are not co-oriented with one another or with the long axis of the rod, as previously assumed: the c-axes of adjacent nanocrystals are most frequently mis-oriented by 1°-30°, and this orientation within each rod gradually changes, with an overall angle spread that is never zero, but varies between 30°-90° within one rod. Molecular dynamics simulations demonstrate that the observed mis-orientations of adjacent crystals induce crack deflection. This toughening mechanism contributes to the unique resilience of enamel, which lasts a lifetime under extreme physical and chemical challenges.

Mitochondrial genome mutations in mesenchymal stem cells derived from human dental induced pluripotent stem cells.

Ethical and safety issues have rendered mesenchymal stem cells (MSCs) popular candidates in regenerative medicine, but their therapeutic capacity is lower than that of induced pluripotent stem cells (iPSCs). This study compared original, dental tissue-derived MSCs with re-differentiated MSCs from iPSCs (iPS-MSCs). CD marker expression in iPS-MSCs was similar to original MSCs. iPS-MSCs expressed higher in pluripotent genes, but lower levels in mesodermal genes than MSCs. In addition, iPS-MSCs did not form teratomas. All iPSCs carried mtDNA mutations; some shared with original MSCs and others not previously detected therein. Shared mutations were synonymous, while novel mutations were non-synonymous or located on RNA-encoding genes. iPS-MSCs also harbored mtDNA mutations transmitted from iPSCs. Selected iPS-MSCs displayed lower mitochondrial respiration than original MSCs. In conclusion, screening for mtDNA mutations in iPSC lines for iPS-MSCs can identify mutation-free cell lines for therapeutic applications. [BMB Reports 2019; 52(12): 689-694].

Periostin plays role in force-induced stem cell potential by periodontal ligament stem cells.

Mechanical stimuli have been shown to play an important role in directing stem cell fate and maintenance of tissue homeostasis. One of the functions of the mechanoresponsive tissue periodontal ligament (PDL) is to withstand the functional forces within the oral cavity. Periodontal ligament stem cells (PDLSCs) derived from periodontal tissue have been demonstrated to be able to respond directly to mechanical forces. However, the mechanisms of action of mechanical force on PDLSCs are not totally understood. The aim of this study was to investigate the mechanisms by which compressive force affects PDLSCs, especially their stemness properties. PDLSCs were established from extracted human third molars; their stem cell characteristics were validated by detecting the expression of stem cell markers and confirming their ability to differentiate into osteogenic and adipogenic lineages. PDLSCs were subjected to various magnitudes of static compressive force (0 [control], 0.5, 1.0, 1.5, or 2 g/cm2 ). Application of 1.0 g/cm2 compressive force significantly upregulated a panel of stem cell marker genes, including NANOG and OCT4. Conversely, higher force magnitudes downregulated these genes. Mechanical loading also upregulated periostin, a matrix protein that plays important roles in tissue morphogenesis. Interestingly, knockdown of periostin using siRNA abolished force-induced stem cell marker expression in PDLSCs. This study suggests a proper magnitude of compressive force could be one important factor involved in the modulation of the pluripotency of PDLSCs through the action of periostin. The precise mechanism by which periostin regulates stemness requires further detailed investigation.

In vitro remineralization of artificial enamel caries with resin composites containing calcium phosphate particles.

The aim of the study was to evaluate the effect of experimental composites containing dicalcium phosphate dihydrate (DCPD) on remineralization of enamel lesions. Five resin-based composites containing equal parts (in mols) of bisphenol-A glycidyl dimethacrylate (BisGMA), triethylene glycol dimethacrylate (TEGDMA), and 60 vol % of fillers were manipulated. Filler phase was constituted by silanized barium glass and 0, 10, or 20 vol % of DPCD particles, either functionalized (F) or nonfunctionalized (NF) with TEGDMA. Artificial subsurface lesions were produced in human enamel fragments and divided according to the resin composite applied on the lesion (no DCPD, 20% NF, 20% F, 10% NF, 10% F) plus a group without composite build-up (nontreated, NT). Fragments were exposed to 16 days of pH cycling. Specimens were evaluated using transverse microradiography (TMR). Calcium and phosphate concentrations in pH-cycling solutions were determined by spectrophotometry. TMR and ionic concentrations were analyzed using one-way ANOVA/Tukey and Kruskal-Wallis/Dunn test, respectively (alpha: 0.05). All composite groups showed enamel remineralization (3%-23%). Higher mineral recovery in the middle (7%-11%) and bottom (2%-7%) thirds of the lesion was observed in groups with DCPD-containing composites compared to the "no DCPD" group (middle: 1%, bottom: -3%). Lesion depth was significantly reduced in groups using DCPD-containing composites compared to NT group. No noticeable increase in calcium and phosphate ions was observed in the pH-cycling solutions due to the presence of DCPD in the composites. In conclusion, composites with DCPD fractions as low as 10%, regardless of functionalization, were able to promote mineral recovery and reduce lesion depth of enamel lesions. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1542-1550, 2019.

TP53 polymorphisms in smokers' and nonsmokers' pericoronal follicles of asymptomatic impacted third molars.

BACKGROUND AND PURPOSE: The investigators designed and implemented a prospective cohort study composed of smoking and nonsmoking patients with asymptomatic fully impacted mandibular third molars. The objective of the paper was to evaluate 21 single-nucleotide polymorphisms (SNP) on the TP53 gene in smokers' (S) and nonsmokers' (NS) pericoronal follicles of asymptomatic impacted third molars. MATERIALS AND METHODS: Matrix-assisted desorption/ionization time of the flight mass spectrometry was used for SNP analysis of 21 regions in the TP53 gene. Descriptive statistics and Chi-square tests were computed with a P value of 0.05. RESULTS: : Ten of the 21 SNPs related to oral pathologies according to NCBI dbSNP, were detected; in these, the genotypic frequencies showed no differences between the S and NS groups (P > 0.05). The results showed a high ratio of SNPs without correlation between smoking and TP53 gene status. CONCLUSION: Further studies should examine the entire TP53 gene to elucidate how smoking affects it in larger study populations.

Population pharmacokinetics of articaine with 1:200,000 epinephrine during third molar surgery and simulation of high-dose regimens.

BACKGROUND AND OBJECTIVES: Articaine is more and more used in third molar surgery under local anesthesia (LA). The objectives of this analysis were to characterize the pharmacokinetics of articaine for this type of surgery and to simulate dosing regimens. METHODS: Non-linear mixed-effects modeling conducted in Monolix 4.4.0 was used to describe articaine plasma concentration-time data from 20 patients. Monte Carlo simulations were then performed to evaluate the probability of cardiotoxic target attainment (PCTA) of various dosage regimens. RESULTS: Articaine concentration data were best described by a linear one-compartment model, with an additional depot compartment for submucosal route with a zero-order transfer to central compartment. Age and gender were found to influence duration transfer (Tk0) and elimination rate constant (Ke), respectively. Simulated maximum recommended dose regimen (7mg/kg) had a PCTA of 0%. Simulated higher doses of 10mg/kg and 15mg/kg had a PCTA of 0% and about 1-4%, respectively. CONCLUSIONS: The model adequately described the articaine pharmacokinetics. This is the first PK model qualified for articaine administered by submucosal route. The simulations suggest that maximum recommended dose regimen is safe concerning the cardiotoxicity in healthy patients.

Teneurin-2 presence in rat and human odontoblasts.

Teneurins are transmembrane proteins consisting of four paralogues (Ten-1-4), notably expressed in the central nervous system during development. All teneurins contain a bioactive peptide in their carboxyl terminal named teneurin C-terminal associated peptide (TCAP). The present study analyzed the detailed distribution of teneurin-2-like immunoreactive (Ten-2-LI) cells in developing and mature rat molar teeth, as well as in mature human dental pulps. Ten-2 and TCAP-2 genic expressions were also evaluated in rat and human dental pulps. Finally, Ten-2-LI cells were analyzed during the repair process after dentin-pulp complex injury in rat lower molar teeth. For this, histological sections of rat molar teeth and human dental pulps were submitted to immunohistochemical techniques, while total RNA from developing rat teeth and mature human dental pulps were submitted to conventional RT-PCR. Ten-2-LI cells were evident in the initial bell stage of rat molar teeth development, especially in ectomesenchymal cells of the dental papilla. Ten-2-LI odontoblasts showed strong immunoreactivity in rat and human mature teeth. Ten-2 and TCAP-2 genic expressions were confirmed in rat and human dental pulps. Dentin-pulp complex injury resulted in a decrease of Ten-2-LI odontoblasts after traumatic injury. Interestingly, Ten-2-LI cells were also evident in the pulp cell-rich zone in all postoperative days. In conclusion, Ten-2-LI presence in rat and human odontoblasts was demonstrated for the first time and Ten-2/TCAP-2 genic expressions were confirmed in rat and human dental pulps. Furthermore, it was revealed that Ten-2-LI rat odontoblasts can be modulated during the regenerative process.

Dental pulp pluripotent-like stem cells (DPPSC), a new stem cell population with chromosomal stability and osteogenic capacity for biomaterials evaluation.

BACKGROUND: Biomaterials are widely used to regenerate or substitute bone tissue. In order to evaluate their potential use for clinical applications, these need to be tested and evaluated in vitro with cell culture models. Frequently, immortalized osteoblastic cell lines are used in these studies. However, their uncontrolled proliferation rate, phenotypic changes or aberrations in mitotic processes limits their use in long-term investigations. Recently, we described a new pluripotent-like subpopulation of dental pulp stem cells derived from the third molars (DPPSC) that shows genetic stability and shares some pluripotent characteristics with embryonic stem cells. In this study we aim to describe the use of DPPSC to test biomaterials, since we believe that the biomaterial cues will be more critical in order to enhance the differentiation of pluripotent stem cells. METHODS: The capacity of DPPSC to differentiate into osteogenic lineage was compared with human sarcoma osteogenic cell line (SAOS-2). Collagen and titanium were used to assess the cell behavior in commonly used biomaterials. The analyses were performed by flow cytometry, alkaline phosphatase and mineralization stains, RT-PCR, immunohistochemistry, scanning electron microscopy, Western blot and enzymatic activity. Moreover, the genetic stability was evaluated and compared before and after differentiation by short-comparative genomic hybridization (sCGH). RESULTS: DPPSC showed excellent differentiation into osteogenic lineages expressing bone-related markers similar to SAOS-2. When cells were cultured on biomaterials, DPPSC showed higher initial adhesion levels. Nevertheless, their osteogenic differentiation showed similar trend among both cell types. Interestingly, only DPPSC maintained a normal chromosomal dosage before and after differentiation on 2D monolayer and on biomaterials. CONCLUSIONS: Taken together, these results promote the use of DPPSC as a new pluripotent-like cell model to evaluate the biocompatibility and the differentiation capacity of biomaterials used in bone regeneration.

Novel human mutation and CRISPR/Cas genome-edited mice reveal the importance of C-terminal domain of MSX1 in tooth and palate development.

Several mutations, located mainly in the MSX1 homeodomain, have been identified in non-syndromic tooth agenesis predominantly affecting premolars and third molars. We identified a novel frameshift mutation of the highly conserved C-terminal domain of MSX1, known as Msx homology domain 6 (MH6), in a Japanese family with non-syndromic tooth agenesis. To investigate the importance of MH6 in tooth development, Msx1 was targeted in mice with CRISPR/Cas system. Although heterozygous MH6 disruption did not alter craniofacial development, homozygous mice exhibited agenesis of lower incisors with or without cleft palate at E16.5. In addition, agenesis of the upper third molars and the lower second and third molars were observed in 4-week-old mutant mice. Although the upper second molars were present, they were abnormally small. These results suggest that the C-terminal domain of MSX1 is important for tooth and palate development, and demonstrate that that CRISPR/Cas system can be used as a tool to assess causality of human disorders in vivo and to study the importance of conserved domains in genes.

IGFBP-2 and -3 co-ordinately regulate IGF1 induced matrix mineralisation of differentiating human dental pulp cells.

Human dental pulp cells (DPCs), which are known to contain a subset of stem cells capable of reforming a dentin and pulp-like complex upon in vivo transplantation, were isolated from third molars of three healthy donors and differentiated to a matrix mineralisation phenotype using by culture in dexamethasone and l-ascorbic acid. qRT-PCR analysis of insulin-like growth factor ( IGF) axis gene expression indicated that all genes, except insulin-like growth factor 1 (IGF1) and insulin-like growth factor binding protein-1 ( IGFBP-1), were expressed in DPCs. During differentiation upregulation of insulin-like growth factor binding protein-2 (IGFBP-2) and downregulation of insulin-like growth factor binding protein-3 (IGFBP-3) expression was observed. Changes in IGFBP-2 and IGFBP-3 mRNA expression were confirmed at the protein level by ELISA of DPC conditioned medium functional analysis indicated that IGF1 stimulated the differentiation of DPCs and that the activity of the growth factor was enhanced by pre-complexation with IGFBP-2 but inhibited by pre-complexation with IGFBP-3. Therefore changes in IGFBP-2 and -3 expression during differentiation form part of a co-ordinated functional response to enhance the pro-differentiative action of IGF1 and represent a novel mechanism for the regulation of DPC differentiation.

UVA-activated riboflavin improves the strength of human dentin.

The aim of this study was to evaluate the effects of UVA-activated riboflavin (UVA-RF) on the mechanical properties of non-demineralized human dentin. Dentin specimens obtained from 20 teeth were randomly divided into the following four groups: group 1 (control): no treatment, group 2 (low UVA-RF): specimens were exposed to UVA-RF for 10 min, group 3 (medium UVA-RF): specimens were exposed to UVA-RF for 30 min, and group 4 (high UVA-RF): specimens were exposed to UVA-RF for 60 min. Three-point flexural test and Raman spectroscopic analyses were performed. The mean flexural strengths (MPa) were 129.96, 128.96, 144.21, and 147.54, and the mean elastic modulus (GPa) were 8.59, 8.38, 10.21, and 9.87 for groups 1 to 4, respectively. Raman spectra showed chemical modifications of dental collagen under medium and high UVA-RF treatment. We conclude that medium and high UVA-RF increases the strength of non-demineralized human dentin by collagen crosslinking.

VEGF and VEGFR2 in dentigerous cysts associated with impacted third molars.

The aims of this study were to determine the presence and distribution of vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptor-2 (VEGFR2) in dentigerous cysts compared with normal dental follicles as a control tissue and to evaluate endothelial cells and proliferating cells as indicators of angiogenic activity in these tissues.Twenty specimens histologically diagnosed as dentigerous cysts and 20 dental follicle specimens were included. Immunohistochemistry (IHC) using anti-VEGF and anti-VEGFR2 antibodies stained for the growth factor and its receptor, while anti-CD34 and anti-CD146 antibodies were used to identify endothelial cells. Anti-proliferating cell nuclear antigen (PCNA) antibody detected proliferating cells within the specimens. Slides were examined microscopically and results evaluated using kappa statistics, negative binomial regression and ordinal logistic regression.The mean age for patients with dentigerous cysts was 23 years and they were more common in males. Proteins for VEGF, VEGFR2, PCNA, CD34, and CD146 were expressed in all dentigerous cysts and dental follicles. VEGF and VEGFR2 were expressed on several cell types within the tissues, however there was a significantly greater percentage of positive staining in dentigerous cysts compared with dental follicles (odds ratio = 31.24, p < 0.001). CD34(+), CD146(+), and PCNA(+) cells were observed in both dentigerous cysts and dental follicles but for all markers there were significantly more positive cells in dentigerous cysts (p < 0.001); this was especially evident in cases associated with inflammation. PCNA was seen in most endothelial cells lining small thin walled blood vessels suggesting endothelial proliferation. There was a high level of intra- and inter-examiner agreement (kappa 0.77 and 0.75, respectively).VEGF and VEGFR2 and angiogenic activity are present in dental follicles and dentigerous cysts and may contribute to local bone resorption for tooth eruption or the development and progression of dentigerous cysts.

The influence of the donor on dental apical papilla stem cell properties.

Stem cells from the human dental apical papilla (SCAP) can be obtained from almost all extracted wisdom teeth with an immature tooth root. Although different stem cell lines are used for studies, it remains elusive whether specific characteristics of the dental stem cell cultures such as proliferation rates or the cell differentiation potential are related to the cell source, e.g. the donor tissue of the dental apical papilla. To answer this question, we compared two independent SCAP cell lines from the same donor and compared them with a third cell line from another donor. We investigated the expression of stem cell markers, the efficiency of colony forming units, cell proliferation and the differentiation potential. Results showed particular differences for typical stem cell attributes such as stem cell marker expression, cell proliferation and the adipogenic differentiation. These differences were regardless of the donor of the cell lines. In conclusion, we suppose that stem cell characteristics of SCAP cell cultures are independent from the donor.

Does smoking affect the Ki67 and p53 expressions in asymptomatic fully impacted lower third molar follicles?

PURPOSE: Ki67 and p53 protein expressions are the most widely used markers to show the pathologic proliferation and early-stage tumoral alterations in vital tissues. The aim of this study was to compare Ki67 and p53 protein expressions in smokers' and nonsmokers' pericoronal follicles of asymptomatic impacted lower third molars (ILTMs). MATERIALS AND METHODS: A cross-sectional study was planned. The study sample was derived from a population of patients who presented for evaluation and operative treatment of asymptomatic ILTMs. The predictor variable was smoking status, defined as smoker or nonsmoker. Outcome variables were Ki67 and p53 protein expressions in ILTM follicles. Other study variables were age, gender, tooth position, cigarette pack-year, epithelial layer staining, and inflammation. Independent-samples t test analyses were conducted with SPSS 10.0 (SPSS, Inc, Chicago, IL), with statistical significance set at a P value equal to .05. RESULTS: The study sample was composed of 70 patients (35 in the smoker group) who contributed 60 follicles. There were statistical differences between the 2 groups for variables Ki67 and p53. Mean expression levels of Ki67 were 3.93 ± 2.17 and 2.48 ± 2.09, respectively, for smokers and nonsmokers (P = .011). Mean expression levels of p53 were 5.32 ± 1.98 and 3.06 ± 2.34, respectively, for smokers and nonsmokers (P = .000). CONCLUSION: The present study showed that dental follicles of smokers have higher Ki67 and p53 protein expressions than nonsmokers' follicles.

Absent in melanoma 2 (AIM2) expressed in human dental pulp mediates IL-1ß secretion in response to cytoplasmic DNA.

The inflammasome has been determined to play an important role in inflammatory diseases in recent years. Absent in melanoma 2 (AIM2), an inflammasome that recognizes cytoplasmic DNA, has recently been identified as a critical regulator of immune responses. In this study, we explored whether AIM2 was expressed in human dental pulp and defined the role of AIM2 in regulating interleukin (IL)-1ß secretion. We demonstrated that AIM2 was only detected in the odontoblast layer of healthy dental pulp, whereas strong expression was observed in inflamed dental pulp. Stimulation with interferon gamma (IFN-γ) and cytoplasmic DNA significantly activated the AIM2 inflammasome and increased IL-1ß secretion in human dental pulp cells (HDPCs) in a time- and dose-dependent manner. Moreover, the knockdown of AIM2 downregulated both cleaved-caspase-1 expression and IL-1ß release in HDPCs. These results suggest that AIM2 expressed in human dental pulp plays an important role in the immune defense by activating the inflammasome signaling pathway.

In vitro mechanical stimulation promoted remineralization at the resin/dentin interface.

INTRODUCTION: Teeth are continuously subjected to mechanical loading during mastication, swallowing and parafunctional habits. The purpose of this study was to evaluate if mechanical loading is able to promote remineralization at etched and bonded dentin interfaces. METHODS: Flat mid-coronal human dentin surfaces were subjected to different treatments: (1) demineralization by 37% phosphoric acid (PA) followed by application of an etch-and-rinse dentin adhesive: Adper™ Single Bond (SB) (PA+SB) or (2) treatment by 0.5M ethylenediaminetetraacetic acid (EDTA) followed by SB (EDTA+SB); (3) application of an self-etch dentin adhesive: Clearfil SE Bond (SEB). Restorations were accomplished, incrementally, with resin composite. In half of the specimens, mechanical loading (100,000 cycles, 3Hz, 49N) was applied. AFM imaging/nano-indentation, Raman spectroscopy/cluster analysis and dye assisted confocal microscopy evaluation (CLSM), were employed to detect remineralization at the interfaces. RESULTS: In general, load cycling increased mechanical properties at the resin-dentin interface. Cluster analysis demonstrated a regular increase of the mineral-matrix ratio in EDTA+SB and SEB loaded specimens. CLSM showed a reduced micropermeability and nanoleakage after loading in bonded interfaces, and a most pronounced reduction in SEB samples. INTERPRETATION: In vitro load cycling promoted remineralization at resin-dentin interfaces. Mineral content increased and nanomechanical properties were improved at both the hybrid layer and bottom of the hybrid layer. Higher mineral concentration in correspondence with a lesser concentration of demineralized dentin was observed, after loading.

Relación de los niveles plasmáticos de proteína C reactiva con infección y edema en la cirugía de los terceros molares retenidos / Relation between CRP levels as indicator of postoperative infection and edema after third molar impacted surgery

La proteína C reactiva CRP (por sus siglas en inglés) es una proteína de fase aguda que se utiliza para el seguimiento de enfermedades inflamatorias tales como artritis reumatoidea, lupus eritematoso o vasculitis y procesos infecciosos tales como sepsis y septicemia; así como también, para evaluar la eficacia de las drogas antiinflamatorias y antimicrobianas indicadas en el tratamiento de estas patologías. Igualmente se ha asociado a daño tisular en diversas especialidades quirúrgicas. El objetivo de este estudio fue relacionar los niveles plasmáticos de CRP con la infección y el edema posterior a la cirugía de los terceros molares. A tal efecto se evaluaron 60 pacientes, distribuidos en 3 grupos A, B y C bajo antibioticoterapia profiláctica con Clindamicina (A: dosis única de 600 mg, B: 300 mg c/6h por 5 días y C: Placebo) y terapia analgésica y antiinflamatoria (Ibuprofeno 400mg c/6h por 3 días). A quienes se tomaron muestras de sangre antes y a las 72 horas de la odontectomía de los terceros molares y fotografías digitales para calcular el área de inflamación. No se demostró la relación de los niveles de CRP con infección ya que ningún paciente presentó proceso infeccioso pero si se demostró la relación cualitativa (sensibilidad) de CRP y cuantitativa mediante correlación de Spearman (p<0,05) ya que mientras mayor fue el área de la inflamación, mayores fueron los niveles plasmáticos de CRP.

The C reactive protein (CRP) is an unspecific acute phase reaction used for the follow-up of such inflammatory diseases such as rheumatoid arthritis, lupus, or vasculitis and such infectious processes like sepsis; as well as also, to evaluate the efficiency of the anti-inflammatory and antimicrobial drugs indicated in the treatment of this pathologies. Equally it has associated to tissue damage in diverse surgical specialties. The aim of this study was to evaluate the relation between CRP levels as indicator of postoperative infection and edema after third molar surgery. We evaluated 60 patients distributed in three groups A, B and C under antibiotic prophylaxis with Clindamycin (A: single dosis 600 mgs, B: 300 mgs each 6/h by 5 days and C: placebo) and analgesic and anti-inflammatory therapy with Ibuprofen 400 mg. each 6/h by 3 days. Who were taken blood samples to measure the CRP before and 72 hours after surgery and digital photographs to calculate the edema area. We did not demonstrated relation between CRP and infection because no one patient was infected in any group but we demonstrated (By Searman (p<0,05) the value of CRP as indicator of edema in the third molar surgery.