Current landmarks for gingival thickness evaluation in maxillary anterior teeth: a systematic review.

OBJECTIVES: To identify and report the current landmarks used for measuring gingival thickness (GT) in healthy maxillary anterior teeth. MATERIAL AND METHODS: The protocol of this Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) 2020-compliant systematic review was registered in PROSPERO. A literature search was conducted to identify articles that met the eligibility criteria published up to 2022. The methods of assessing gingival thickness and the landmarks adopted on the studies were described. Primary outcomes were identified, and the frequency of reporting in the selected articles was calculated. Additionally, risk-of-bias assessments were performed for individual articles. RESULTS: Fifty-eight articles (34 with low risk of bias and 24 with medium risk of bias) were selected. A total of 3638 individuals had their gingival thickness measured. Thirty-nine different landmarks were adopted in the studies. Fifty-six articles with 22 landmarks were included in the meta-analysis. A higher heterogeneity was found between the studies (GT ranged from 0.48 to 2.59 mm, mean GT 1.074; 95% CI: 1.024-1.104). The 3 most used landmarks were 2 mm from gingival margin (10 studies, mean GT 1.170 mm, 95% CI: 1.085-1.254), bone crest (9 studies, mean GT 1.01 mm; 95% CI: 0.937-1.083), and cemento-enamel junction (7 studies, mean GT 1.172 mm; 95% CI: 1.105, 1.239). CONCLUSIONS: Within the limits of this study, a large heterogeneity in GT was found, and there was no consensus on the ideal landmark for GT measurement. CLINICAL RELEVANCE: The landmark 2 mm from gingival margin, located at attached gingiva, can be used for GT measurement by clinical and image-based devices. This is an important step for a quantitative instead of a qualitative evaluation of phenotypes.

Age-dependent effect between MARCO and TLR4 on PMMA particle phagocytosis by macrophages.

Progressive generation of total joint implant-derived wear particles is one of the major risk factors in development of peri-prosthetic osteolysis especially in the aging society. It is commonly accepted that macrophages predominantly drive the inflammatory response to wear debris particles. Among various surface receptors that activate the macrophages to phagocytize particles, it is believed that the Toll-like receptor 4 (TLR4) and the scavenger macrophage receptor with collagenous structure (MARCO) play key roles in recognition of wear debris particles. However, a strong body of evidence indicates an age-dependent diminished function of human TLRs. Thus, we hypothesized that the MARCO receptor may be more engaged than TLRs in the phagocytosis of wear debris particles which in turn up-regulate production of pro-inflammatory cytokines from aged macrophages. We demonstrated that peritoneal macrophages isolated from aged mice show elevated expression of MARCO receptor compared to that from young mice. In contrast the expression of TLR4 was significantly decreased on the surface of aged macrophages. Furthermore, using anti-MARCO and anti-TLR4 neutralizing mAbs, we demonstrated the age-dependent pathogenic role of MARCO, but not TLR4, receptor in promoting poly-methyl methacrylate (PMMA) bone cement particles phagocytosis by macrophages leading to the release of pro-inflammatory cytokines migration inhibitory factor and tumour necrosis factor in vitro. These data also suggest that the approach to neutralize MARCO may lead to the development of therapeutic regimen for the prevention of particle-induced osteolysis in aged patients.

Fixed Rehabilitation of Edentulous Mandibles Using 2 to 4 Implants: A Systematic Review.

OBJECTIVE: This systematic review evaluated survival rates, marginal bone loss (MBL), and complications of using 2 to 4 implants to support full-arch fixed prostheses in the mandible. MATERIALS AND METHODS: An electronic search was performed in PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials to identify relevant articles published until March 2015. Articles were critically reviewed to determine the level of quality. RESULTS: The initial search resulted in 910 articles from PubMed/MEDLINE, 162 titles from the Cochrane Central Register of Controlled Trials, and 363 from the Web of Science. After an initial assessment and careful reading, 19 studies published between 1999 and 2014 were included in this review. CONCLUSIONS: The results of this review suggest that full-arch fixed dental prosthesis in mandible supported by 2 to 4 implants exhibited a low rate of failures for implants and prostheses, a low rate of MBL, and a low rate of biomechanical and biological complications.

Posterior Cervical Glomus Tumor Mimicking Neurogenic Occipital Pain.

Glomus tumors, typically localized in digits, palms, and soles, rarely occur in the posterior cervical region. This case report describes a unique presentation of an epithelioid glomus tumor in a 49-year-old male with a history of progressive occipital headaches. A 49-year-old male, referred with a five-year history of worsening occipital headaches, presented a palpable lesion in the right suboccipital area. MRI identified a 2.3 cm subcutaneous lesion adjacent to the right occipital artery, raising initial suspicion of a schwannoma. Subsequent excisional biopsy unveiled an unexpected diagnosis - an epithelioid glomus tumor. The rarity of glomus tumors in the posterior cervical region, coupled with their potential to mimic neurogenic tumors like schwannomas, underscores the diagnostic complexity. This encounter of a glomus tumor in an uncommon posterior cervical location serves as a pertinent reminder for neurosurgeons to consider atypical differentials. This case underscores the need for heightened clinical vigilance when faced with unusual presentations in neurosurgical practice.

Surgical Strategies for Tuberculous Spondylodiscitis With Severe Osteoporosis: A Case Illustrating the Challenges of Delayed Intervention.

Tuberculous spondylodiscitis (Pott's spine) is a complex extrapulmonary manifestation of tuberculosis (TB) that poses significant medical challenges, characterized by vertebral destruction affecting approximately 2% of all TB cases. The management of this condition involves a multidisciplinary approach, with surgical intervention indicated for specific cases, including those with neurological complications, spinal instability, and kyphosis. We report a case of a 49-year-old female with a confirmed diagnosis of tuberculous spondylodiscitis who had undergone eight months of tuberculostatic therapy. She was referred for neurosurgical consultation due to uncontrollable axial pain, despite favorable clinical and imaging responses, which had rendered her immobile for six months. Imaging revealed a complete collapse of the L5 vertebral body, and a complementary dual x-ray absorptiometry (DEXA) scan demonstrated severe osteoporosis. A two-stage surgical approach was chosen to address her condition, involving corpectomy through an anterior approach, followed by lumbopelvic stabilization. Postoperative recovery was uneventful, with progressive improvement in pain and mobility. This case highlights the challenges of managing tuberculous spondylodiscitis and underscores the significance of early detection to prevent complications like severe osteoporosis. In this case, delayed referral for surgery following an extended period of immobility added complexity to an already difficult case. The severe osteoporosis, with a t-score of -5.7, had a substantial impact on surgical planning, leading to a more robust approach to arthrodesis with substantial lumbopelvic instrumentation in order to mitigate the risks associated with implant failure. This case shows that timely intervention and a comprehensive multidisciplinary approach are essential for the effective management of tuberculous spondylodiscitis, especially in cases complicated by severe osteoporosis.

Systematic review of the effect of probiotics on experimental gingivitis in humans.

Probiotic therapy is a viable alternative to chlorhexidine, a widely used antiseptic in dentistry that produces significant adverse effects. This systematic review aimed to analyze the effects of probiotics on experimental gingivitis in humans. Two independent reviewers conducted a comprehensive literature search until March 2019. Randomized clinical trials and controlled clinical trials were selected. Outcome data were extracted and critically analyzed. A total of five articles were included in the qualitative synthesis. No meta-analysis could be conducted due to the heterogeneity of the selected studies. The use of probiotics showed a slight improvement in clinical parameters. Changes in gingival crevicular fluid volume were lower in the presence of the probiotic than in the placebo group. All the studies showed that the immediate, positive effects of probiotics during the period of discontinued mechanical oral hygiene were due to the modulation of the host response, not the anti-plaque effect. Investigators should conduct randomized clinical trials to elucidate the mechanisms of probiotic action and develop improved delivery systems.

The influence of abutment disconnections on peri-implant marginal bone: A systematic review.

PURPOSE: To assess the failure rate of dental implants and prosthetic restoration, complications and marginal bone loss (MBL) of implants restored with an immediate definitive abutment at the time of the implant placement, and implants that were evaluated according to a standard prosthetic protocol (SPP), which includes multiple abutment changes. MATERIALS AND METHODS: This systematic review followed the guidelines of the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). An electronic search with no date or language restriction was run in January 2018 in the PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, and complemented with a manual search. Randomised clinical trials with at least a 12-month follow-up evaluating the use of a definitive abutment and a SPP were included. The Cochrane Collaboration Risk of Bias tool was used to evaluate the included studies. The outcome measures were: implant and prosthetic failure; aesthetics; complications; and peri-implant MBL. The results were pooled using a random-effect model with mean differences (MDs) for continuous outcomes and risk ratio for dichotomous outcomes with a 95% confidence interval (CI). RESULTS: The search identified a total of 714 studies. After the screening process five studies were included in the analysis. The five studies included had a limited sample size, a short follow-up period, and four studies were considered at high risk of bias. The meta-analysis revealed that five studies using an immediate definitive abutment over a 12- to 18-month follow-up resulted in lower MBL, with a MD of -0.32 mm (95% CI -0.45 to -0.19: P < 0.0000). At the end of a 3-year follow-up two studies showed a MD of -0.33 mm (95% CI -0.63 to -0.03: P = 0.03, which also favours the definitive abutment group. Regarding implant failure rate, complications, and probing depth, no significant difference was found between the groups. CONCLUSIONS: Within the limitations of this meta-analysis, reducing the number of abutment changes contributes to statistically significant lower MBL. However, the clinical significance of this reduction in bone loss should be interpreted with caution. A high implant success rate was reported by all studies for both control and test groups.

A faixa de mucosa queratinizada é importante para a saúde peri-implantar? Uma discussão crítica da literatura / Is the keratinized mucosa attached important for peri-implant health? A discussion critic of literature

A gengiva oral pode ser dividida em inserida ou livre. A gengiva inserida é queratinizada e apresenta grande importância na proteção do periodonto contra inflamações, sendo importante na proteção mecânica durante à escovação e ao acúmulo de biofilme. Uma faixa de gengiva queratinizada aderida é importante para a saúde dos tecidos periodontais. Os tecidos peri-implantares tem aspecto e estruturas parecidas com o epitélio ao redor dos dentes. A faixa de mucosa queratinizada ao redor da área peri-implantar de 1 a 2mm pode diminuir o acúmulo de placa e consequentemente a peri-implantite que é um dos fatores responsáveis pela perda de implantes. Diversas técnicas têm sido utilizadas para se ter um aumento dessa faixa de mucosa queratinizada favorecendo um aumento da taxa de sucesso instalações de implantes como: enxertos gengivais livres, de tecido conjuntivo, de matriz dérmica acelular, de matriz de colágeno, membranas e implantes imediatos ao invés da técnica comum. O objetivo do estudo foi discutir as características anatômicas da mucosa aderida ao redor de implantes e sua importância para saúde peri-implantar. Para o desenvolvimento do estudo proposto de revisão da literatura, foram realizadas pesquisas em diferentes plataformas de bases de dados bibliográficos sendo: Scielo (scientific Eletronic Library online), PubMed e Google Acadêmico e livros de referência na área da Periodontia. Com base, na revisão crítica realizada, conclui-se que, quando há a presença de uma mucosa queratinizada aderida ao redor do implante maior que 1mm, os implantes apresentam melhor selamento biológico, menor acúmulo de biofilme e baixo risco para a peri-implantite.

The oral gingiva can be divided into attached or free. The attached gingiva is keratinized and is of great importance in protecting the periodontium against inflammation, being also important in mechanical protection during brushing and biofilm accumulation. A range of keratinized mucosa is important for the health of periodontal tissues. Peri-implant tissues have an appearance and structures similar to the epithelium around the teeth. The keratinized mucosa range around the peri-implant area of ​​1 to 2 mm can reduce plaque accumulation and consequently peri-implantitis, which is one of the factors responsible for implant loss. Several techniques have been used to increase this range of keratinized gingiva, favoring an increase in the success rate of implant installations such as: free gingival grafts, connective tissue, acellular dermal matrix, collagen matrix, membranes, and immediate implants. instead of the common technique. The aim of the present study was to discuss, based on the scientific literature, the anatomical characteristics of the keratinized attached mucosa around implants and their importance for peri-implant health. For the development of the proposed study of literature review, searches were carried out on different platforms of bibliographic databases, namely: Scielo (scientific Electronic Library online), PubMed and Google Scholar and reference books in ​​Periodontics. Based on the critical review performed, it was concluded that when there is a keratinized mucosa adhered around the implant greater than 1mm, the implants present better biological sealing, less biofilm accumulation and low risk for peri-implantitis.

Hypernociception and wound healing after application of cyanoacrylate ester as a tissue adhesive in rats.

OBJECTIVE: The present study assessed and compared postoperative hypernociception and skin healing after cyanoacrylate and classic suture as well as analyzed morphologic features of the tissue repair. STUDY DESIGN: The intensity of hypernociception was measured with an electronic pressure-meter test. Rats were given an incised wound in the middle of the palms of the right and left paws. The left side was treated with a silk suture, and the right with cyanoacrylate. Control groups were treated locally with dipyrone or received a systemic pretreatment with valdecoxib. RESULTS: Cyanoacrylate was associated with less inflammation (first week), and the healing wound site was rich in collagenous extracellular matrix and neovascularization. Dipyrone in combination with cyanoacrylate greatly increased the antinociceptive effect. These results were not repeated after systemic treatment with valdecoxib, suggesting that the antinociceptive effect seen in the tissue adhesive was due to formation of a physical barrier.

Endemic hepatitis B and C virus infection in a Brazilian Eastern Amazon region.

CONTEXT: Hepatitis B and hepatitis C infection has been an important cause of morbidity and mortality around the world. However there are few investigations regarding the prevalence and possible risk factors for these diseases in Brazil, particularly in Amazon region, where there are some endemic focus. OBJECTIVES: To determine the prevalence of hepatitis B and hepatitis C in the city of Buriticupu, MA, located in the Brazilian Eastern Amazon region, and try to explore the risk factors for these infections in that area. METHODS: Two hundred forty three subjects (46.5% male and 53.5% female) were investigated. RESULTS: The prevalence of past or current infection of hepatitis B and C virus was, respectively, 40.74% and 5.76%. Positivity for HBsAg was found in 2.88% of the subjects. The prevalence of current infection or chronic virus carriers found was 2.88% (HBsAg). There was a statistically significant relationship between the sera-prevalence of anti-HBc and the distance of the residence from the city center which may reflect an indirect association between the infection and precarious conditions of existence. Individuals with age equal or greater than 60 years were also more likely to be anti-HBc positive which could only reflect that older people have a longer history of exposure to hepatitis B infection. The prevalence of hepatitis C is higher than the worldwide estimate. CONCLUSION: Buriticupu may be considered endemic for hepatitis B and C. Hepatitis B infection could be related to precarious living conditions and old age. Hepatitis C was not associated with the variables investigated in the present investigation.

Coarctação aórtica atípica como etiologia de hipertensão arterial e insuficiência cardíaca grave em mulher de 55 anos / Atypical aortic coarctation as the etiology of hypertension and severe heart failure in 55 year old woman

Mulher de 55 anos, com história de hipertensão arterial sistêmica há 10 anos, apresentando piora progressiva do controle da pressão arterial (PA) nos últimos 10 meses associada a dispneia progressiva e episódio de edema agudo de pulmão hipertensivo (PA: 260 x 110 mmHg). Ao exame apresentava sopro sistólico em foco cervical e diferença de PA nos membros superiores. Ecocardiograma revelou disfunção sistólica importante e hipertrofia ventricular grave. Foi feito diagnóstico de coarctação de aorta atípica por angiorressonância. Após a correção cirúrgica, paciente evoluiu com controle pressórico adequado, sem insuficiência cardíaca e com normalização da função eestrutura ventricular.

A 55 year-old woman with history of systemic hypertension for the past 10 years, in the past 10 months she reported worsening of blood pressure levels accompanied by progressive shortness of breath and an episode of hypertensive acute pulmonary edema (BP: 260 x 110mmHg). On examination a cervical systolic murmur anda difference in blood pressure levels on superior limbs were found. Echocardiogram showed severe systolic dysfunction and ventricular hypertrophy. The diagnosisof atypical coarctation of aorta by angioresonance was made. After surgical repair the patient achieved better blood pressure control and a remarkable improvement inventricular performance.

Endemic hepatitis b and c virus infection in a brazilian eastern amazon region

CONTEXT: Hepatitis B and hepatitis C infection has been an important cause of morbidity and mortality around the world. However there are few investigations regarding the prevalence and possible risk factors for these diseases in Brazil, particularly in Amazon region, where there are some endemic focus. OBJECTIVES: To determine the prevalence of hepatitis B and hepatitis C in the city of Buriticupu, MA, located in the Brazilian Eastern Amazon region, and try to explore the risk factors for these infections in that area. METHODS: Two hundred forty three subjects (46.5 percent male and 53.5 percent female) were investigated. RESULTS: The prevalence of past or current infection of hepatitis B and C virus was, respectively, 40.74 percent and 5.76 percent. Positivity for HBsAg was found in 2.88 percent of the subjects. The prevalence of current infection or chronic virus carriers found was 2.88 percent (HBsAg). There was a statistically significant relationship between the sera-prevalence of anti-HBc and the distance of the residence from the city center which may reflect an indirect association between the infection and precarious conditions of existence. Individuals with age equal or greater than 60 years were also more likely to be anti-HBc positive which could only reflect that older people have a longer history of exposure to hepatitis B infection. The prevalence of hepatitis C is higher than the worldwide estimate. CONCLUSION: Buriticupu may be considered endemic for hepatitis B and C. Hepatitis B infection could be related to precarious living conditions and old age. Hepatitis C was not associated with the variables investigated in the present investigation.

CONTEXTO: Infecção por hepatites B e C tem sido causa importante de morbimortalidade em todo o mundo. Entretanto, há poucas investigações sobre a prevalência e possíveis fatores de risco relacionados a tais doenças no Brasil, especialmente na região amazônica, onde há algumas regiões endêmicas para tais quadros clínicos. OBJETIVOS: Detectar a prevalência de hepatites B e C na cidade de Buriticupu, MA, localizada na região leste da Amazônia brasileira, e tentar investigar seus fatores de risco nessa área. MÉTODOS: Duzentos e quarenta e três indivíduos (46,5 por cento masculinos e 53,5 por cento femininos) foram investigados. RESULTADOS: A prevalência de hepatite C foi de 5,71 por cento (anti-HCV) e a de hepatite B foi de 40,74 por cento (anti-HBc). A prevalência de indivíduos com infecção atual ou com infecção crônica foi de 2,80 por cento (HBsAg). Houve relação estatisticamente significante entre anti-HBc e a distância da residência dos indivíduos do centro da cidade, o que pode refletir uma associação indireta entre tal quadro infeccioso e condições precárias de existência. Indivíduos com idade igual ou maior a 60 anos também apresentaram maior chance de apresentarem sorologia para anti-HBc, o que pode refletir apenas que pessoas mais velhas apresentam história maior de exposição à infecção. A prevalência de hepatite C é maior do que a mundial estimada. CONCLUSÃO: Buriticupu pode ser considerada endêmica para hepatites B e C. Hepatite B pode estar relacionada com precárias condições de vida e idade avançada. Hepatite C não foi associada com as variáveis investigadas na presente investigação.

Cicatrização de alvéolos pós-extração em humanos / Healing of post-extraction sockets in humans: a literature review

A procura pela reabilitação dos dentes perdidos através dos implantes dentários cresce a cada dia. Diante disso, o conhecimento do processo de cicatrização dos alvéolos pós-extração torna-se fundamental para um correto planejamento dos casos. Imediatamente após uma exodontia, inicia-se um processo de reparo no interior do alvéolo com a formação de um coágulo rico em células e fatores de crescimento que guiarão uma neoformação e remodelamento ósseo, e epitelização dos tecidos moles. Contudo, durante esse processo, está bem documentado na literatura que o rebordo alveolar sofre alterações dimensionais importantes, tanto em altura quanto em espessura, que poderão, se não minimizadas, ter uma influência negativa para a instalação do implante e a estética, principalmente nas regiões anteriores. O conhecimento da dinâmica de regeneração dos tecidos pós-extração proporciona aos profissionais a escolha do momento ideal para a futura instalação dos implantes, bem como fornece uma maior previsibilidade das alterações teciduais adjacentes aos alvéolos.

The demand for the rehabilitation of missing teeth through dental implants grows every day. Moreover, the knowledge of the healing process of the post-extraction sockets becomes essential for a proper planning of the cases. Immediately after a dental extraction, begins a process of repair inside the socket with the formation of a clot rich in cells and growth factors that will guide a neoformation and bone remodeling and epithelization of soft tissues. However, during this process, is well document in the literature that the alveolar ridge undergoes dimensional changes important, both in height and thickness, which may, if not minimized, have a negative influence for the installation of the implant and the esthetics, especially in the anterior regions. The knowledge of the dynamics of regeneration of tissues postextraction, provides professionals the choice of the ideal moment for the future installation of implants, as well as provides a greater predictability of tissue changes adjacent to sockets.