Correlations between Immune Response and Etiopathogenic Factors of Medication-Related Osteonecrosis of the Jaw in Cancer Patients Treated with Zoledronic Acid

Impairment of the immune response in MRONJ (medication-related osteonecrosis of the jaws) is one of the still unclear etiopathogenic mechanisms of this condition encountered in cancer patients treated with bisphosphonates, with negative effects on the patient's quality of life. The aim of the present study was to correlate the immune response with etiopathogenic factors via immunohistochemical evaluation of the maxillary tissues in zoledronic acid osteonecrosis. The retrospective study included a group of 51 patients with various types of cancers, diagnosed with stage 2 or 3 MRONJ at zoledronic acid and treated surgically. Immunohistochemical expressions of αSMA, CD3, CD4, CD8, CD20, CD79α, CD68, CD204, and tryptase were evaluated. Immunohistochemical markers expressions were statistically analyzed according to the duration of the treatment, the trigger factor, the location of the MRONJ, and the healing status. Analysis of the immune response included T lymphocytes, B lymphocytes, plasma cells, macrophages, and mast cells. The duration of treatment significantly influenced the immunohistochemical expression of most markers (p < 0.05). For an increasing trend in treatment duration, a decreasing trend in marker score was observed, suggesting an inverse correlation. The expression of the markers was different depending on the trigger factor, on MRONJ localization (maxilla/mandible), and the healing status, being more intense in patients cured per primam compared to those who had relapses. The patient's immune response was negatively influenced by the duration of the treatment, the trigger factor, the location of the lesion in the mandible, and the recurrence of MRONJ.

Morphological and Optical Coherence Tomography Aspects of Non-Carious Cervical Lesions

Non-carious cervical lesions (NCCLs) are considered the irreversible losses of dental hard tissues at the cemento-enamel junction, in the absence of acute trauma and dental caries. The aim of this study was to highlight the presence of NCCLs in cervical areas based on specific macroscopic aspects in order to establish their clinical form, size and location and to confirm the role of optical coherence tomography (OCT) examination in the early diagnosis of these lesions. For this study, 52 extracted teeth were used, which did not have endodontic treatments, fillings or carious lesions in the cervical area. All teeth were examined macroscopically and OCT was used to evaluate the degree of occlusal wear, the presence and clinical form of NCCLs. Most NCCLs were identified on the buccal surfaces of the premolars. The most frequently encountered clinical form was the wedge-shaped form, with a radicular location. NCCLs present most frequently in the wedge-shaped form. Teeth that presented several NCCLs were identified. The OCT examination is an adjunct method to evaluate the clinical forms of NCCL.

Aspects of Dental Occlusion Assessed with the T-Scan System among a Group of Romanian Dental Students in a Cross-Sectional Study

This study evaluated the occlusal relationships in students with bruxism, using the T-Scan III system, and their correlation with the activity of the masticatory muscles assessed through surface electromyography (sEMG). The study group was divided into two subgroups (based on self-reporting): 20 participants with possible bruxism and 20 participants without possible bruxism; all participants underwent the following evaluations: sEMG recordings using the dia-BRUXO device for masticatory muscles assessment, as well as static and dynamic occlusion using the T-SCAN III system. The analysis of the maximum intercuspidal (MI) position revealed a positive moderate association between the values of the occlusal forces in MI distributed along the two hemiarches, and the number of grinding events during daytime, which was statistically significant (p < 0.05). The analysis of protrusion movements reflected statistically significant differences between the non-working interferences and sEMG parameters specific to bruxism (p < 0.05). The analysis of laterotrusion movements indicated that participants with anterolateral guidance presented higher values of awake bruxism indexes and higher values of clenching events during nighttime. For all three mandibular movements, their duration was higher for the study group compared to the control group. Therefore, this study confirmed the utility of sEMG recordings in the bruxism diagnosis process, as well as the association between dental occlusion and bruxism.

Ecological Momentary Assessment of Masseter Muscle Activity in Patients with Bruxism

According to the International Bruxism Consensus, bruxism refers to the activity of the masticatory muscles reflecting contraction disorders, regardless of whether it is during sleep (SB) or an awake (AB) state. The objective of the present study was to evaluate the activity of the masseter muscle by surface electromyographic (sEMG) recordings. This study was performed on 20 participants with self-reported “possible bruxism” (study group) and 20 participants with no self-reported bruxism (control group); all participants underwent an evaluation of the masseter muscle activity using the dia-BRUXO device, which provides numerical parameters regarding sEMG (the total duration and the type of bruxism specific events, the effort made by the masticatory muscles during the recording period, and the personal bruxism index of each participant). Participants from the study group presented more clenching events during AB, three times more frequent than the control group (p = 0.002, Mann−Whitney U test); for SB, the frequency of clenching and grinding events was comparable within the study group, being more frequent than for the control group; the mean value of the effort index was higher for AB (1.177%) than SB (0.470%) and the same for the duration index, with a mean value of 2.788% for AB and 1.054% for SB. All participants from the control group presented reduced values for all acquired parameters. Overall, the personal bruxism index in AB was approximately four times higher for the study group (2.251%) compared to the control group (0.585%) (p < 0.005, Mann−Whitney U test). Similar values were obtained for SB. All participants with “possible bruxism” from the study group presented a higher activity of the masseter muscle, which is specific for bruxism, thus being defined as “definite bruxism”.

Etiology Study of Acquired Developmental Defects of Enamel and Their Association with Dental Caries in Children between 3 and 19 Years Old from Dolj County, Romania

Background: Developmental defects of enamel (DDE) are frequently encountered in primary and permanent teeth, yet their etiology is not completely known. Enamel hypoplasia is considered a predisposing factor for early caries. The objective of this study was the evaluation of several risk factors potentially causing DDE and the possible association between DDE and dental caries. Methods: This study was performed on a group of 213 rural children from Romania. It combined a thorough dental examination for all children, and a questionnaire filled in by their mothers, regarding the evolution of their pregnancy and the child’s health status in the first years of life. Results: There was no statistically significant association between DDE presence and data regarding the evolution of pregnancy, mothers’ health status or children’s conditions during early childhood. There was a significant association between the use of amoxicillin, ibuprofen, and cephalosporin during the period of formation of permanent teeth, and one environmental factor (water source), and the presence of DDE (Chi Square, p < 0.05). Also, DDEs were associated with the presence of caries (Fisher, p = 0.001). Conclusions: Children who consumed water from private wells and children who received medication during early childhood developed more enamel defects, presenting a higher risk of caries development.

Translation and validation of the ageism scale for dental students in Romanian (ASDS-Rom)

AIMS

The aim of this paper was to validate the Romanian version of an ageism scale for dental students.

MATERIALS AND METHODS

The initial 27-item ageism scale was translated into Romanian and administered to 210 dental students in Craiova. The data were analysed using principal components analysis (PCA) with an orthogonal, Varimax rotation. The answers were then compared across several demographic variables using a combination of independent samples t tests and one-way between-subjects analysis of variance (ANOVA).

RESULTS

Adequate factorability was confirmed with a Kaiser-Meyer-Olkin (KMO) of 0.676 and a Bartlett's Test of Sphericity yielding P < 0.001. PCA revealed a 10-item scale distributed into three components that accounted for 58% of the overall variance. The first component contained 4 items related to the cost-benefit of providing care to older patients (α = 0.80). The second contained 3 items that revolved around the perceptions about older people and their value in the society (α = 0.59). The third contained 3 items related to gerodontology training (α = 0.46). Discriminant validity showed differences in the first component based on whether a student had an older family member.

CONCLUSIONS

The 10-item, three components scale demonstrated acceptable validity and reliability.

Dimensional Changes in Co-Cr Alloys and Titanium Framework of Removable Partial Dentures Evaluation of the dimensions of the dental clasps

Removable partial denture are prosthetic solutions that replace missing teeth of partially edentulous patients, ensuring stomatognathic system functionality with affordable costs.The purpose of this study is to analyze the dimensional variations caused by the execution errors, which can lead to premature deterioration of the removable partial dentures and to conclude what sizes are deficient and can lead to the deterioration of the prosthetic part. The material involved in the present study was represented by the metal framework of 181 removable partial dentures. Of the total of 181 removable prosthetic parts, 88 were maxillary prostheses and 93 were mandibular prostheses. Measurements were made at the retentive arms, opposing arms, minor connectors, rests and junction areas between the body of the clasps and the active arms and studied compared to the edentulous classes. The results are focused on dimensional changes of both the retentive arms and the opposing arms of the clasps, which are roughly modeled in the first 3 edentulous classes, with a significant difference from those achieved in Kennedy`s 4th class edentulous, where these segments of the clasps are much shorter. Regarding the size of the rests, although their thickness approximates the values indicated in the literature, they do not fit into the occlusal relief of the tooth. The length of the retentive arms varies according to the classes of edentulous, the clinical situation, but also the size and type of the tooth (premolars, molars) on which the clasp is applied. Regarding the opposing arm, the observed differences cannot be correlated with the objective criteria of their achievement because the attention is directed towards the realization of the retentive arm.

Review of Different Materials that can be CAD/CAM Processed Description, chemical composition, indications in dentistry areas

The objective of this paper is to inform on the indications, appearance and advantages offered by each category of materials used in CAD / CAM technique for different prosthetic restorations.Modern techniques in restorative dentistry include CAD/CAM systems and materials that can be CAD/CAM processed. It is very important to know the physical-chemical properties and the indications of these materials to translate the patient�s wishes to reality providing the ideal restoration. There are a variety of CAD/CAM materials to choose from, all designed to provide efficient restoration design and production. We can choose from available materiales including glass ceramics, nano ceramics, zirconia, hybrid ceramics, BioHPP, in blocks or disks form.

Biochemical and Morphological Modifications in a Patient with Acromegaly in Correlation with Oral Rehabilitation

The purpose of this study was to evaluate the persistence of prosthetic treatment in a patient with morphological and biochemical alterations specific to acromegaly, which consists of a fixed prosthetic restoration. Acromegaly is a chronic multi-systemic endocrine disease due to an excess of hormones (GH = growth hormone) or growth factor (IGF-1 insulin-like growth factor) attributed to pituitary disorders. Morphological signs and symptoms of acromegaly are particularly visible in the face and extremities. We performed a prosthetic therapy to a 36-year-old acromegaly patient, consisting of a full arch bridge for maxilla and three mandible bridges. We applied an original method for reducing the thickness of the metal on the occlusal surface of the crowns. We have observed the evolution of the patient for 20 years. Morphological changes over time in the mandible arch have caused the decementation of the bridge in the frontal area and the enhancement of the lateral cross-bite, insignificant changes that did not endanger dento-maxillary functionality. The case treated by us demonstrates that fixed dentures can be applied to acromegaly patients with multiple edentations, with the condition of supervising the patient over the time.

OCT Application in Direct Dental Restorations Marginal Fit Evaluation

To apply OCT analysis in secondary caries and marginal gap detection and evaluation for direct dental restorations is the aim of the paper. 15 extracted teeth with pre-existing direct dental restorations were analysed through OCT to evaluate marginal fit of restorations. The OCT system used wasmanufactured by Thorlabs (OCS1300SS), powered by a swept laser source with central 1310 nm wavelength, 100 nm spectral bandwidth and 12 mW average power. The occlusal area of the teeth was sampled pictured in 10 mm width, 10 mm distance and 3 mm depth. OCT was used also to evaluate in micrometers (mm) the maximum marginal gap between dental filling and tooth. OCT analysis of the marginal fit of direct dental restorations after A scan examination revealed that amalgam had the smallest marginal gap (width 210 mm, depth 90 mm), followed by glass ionomer (width 350 mm, depth 280 mm), and composite (width 520 mm, depth 300 mm). OCT analysis revealed that for marginal fit evaluation amalgam had best performance, followed by glass ionomer, and ultimately, by resin composite. OCT could be used as an alternative method to appreciate the marginal fit of direct dental restorations giving details that could help dentists to take best treatment decision, whether to repair or to replace the restorations.

Root Resorption Diagnostic: Role of Digital Panoramic Radiography

INTRODUCTION

Root resorption is a pathological process characterized by loss of dental root substance, caused by bacterial infections, traumatic injuries or chemical irritation. Root resorption might be accidentally observed on digital panoramic radiography.

OBJECTIVE

The objective of the study was to identify characteristic radiological aspects for the different types of root resorption that could be observed on digital panoramic radiography, to make an easier diagnostic of root resorption.

MATERIAL AND METHOD

The retrospective study used the X-ray base from the Oral Rehabilitation and Dental Prosthetics Clinic of UMF Craiova to identify the most representative images for different types of root resorption. Digital panoramic radiographies were analysed by two investigators, of which the most suggestive images were selected and described.

RESULTS

Digital panoramic radiographies and dental charts of 240 patients were analyzed. 113 cases of root resorption were identified. External inflammatory root resorption (EIRR) was present in 27.07% of studied cases, external cervical root resorption (ECRR) was identified in 10.83% of all studied cases, external replacement root resorption (ERRR) was diagnosed in 7.08% of studied cases and internal root resorption (IRR) was the most rare type of root resorption, with only 2.08% from all studied cases. 16 cases were selected to describe the radiologic features of different types of root resorption, featuring the most interesting images of root resorption evident on digital panoramic radiographies.

DISCUSSION

Comparative analyses have been made between our results and the results of other specific studies, with both similar and different values. The radiological features which lead to the diagnostic of each type of RR were highlighted, assessing the causes that caused the lesions, as well as the treatment recommendations.

CONCLUSIONS

Digital panoramic radiography is a useful tool to identify root resorption, since it has become the most common radiological investigation for diagnostic in dentistry. Description of radiological aspects of different types of root resorption on panoramic digital radiography allows faster diagnosis. Still, the CBCT may be recommended in some cases to confirm the diagnosis.

Morphological features of tongue squamous cell carcinoma diagnosed in Dolj County population between 2012-2014

Tongue squamous carcinoma can be found in many forms, having a lot of risk factors, and whose morphological characteristics can be used as a prognostic. The purpose of this study was to histologically characterize a number of 54 patients diagnosed between 2012-2014, with tongue squamous carcinoma. Surgical resection specimens of tongue tumors were processed by paraffin inclusion technique. The diagnose samples were reevaluated according to the World Health Organization (WHO) criteria for head and neck tumors diagnosis, by screening the Hematoxylin-Eosin staining sections. The most common histopathological variety of tongue carcinoma observed in our cases was the non-keratinized form, the basaloid and sarcomatoid types of carcinoma being ranked on the last places. The study outlined the prevalence of non-keratinized forms of tongue squamous carcinoma and all types of tumoral invasion patterns have been observed in different percentages.

Root fractures: epidemiological, clinical and radiographic aspects

Chronic root fractures are a relative frequent dental condition, occurring both in vital teeth and in teeth with root canal treatment, with a difficult and frustrating diagnosis. Two clinical forms are described: crown-root fractures with crown origin and vertical root fractures with root origin. The aim of the study was to determine the prevalence of the root fractured extracted teeth in two dental clinics with different profile [oral rehabilitation (OR) and endodontics (E)] and to present some particular aspects of the root fractures. A retrospective study over a period of five years was performed to determine the number of extracted teeth and the motives for extraction. For root fractured extracted teeth were noted: fracture type, tooth vitality, restoration type. Although the number of the patients with tooth extractions in the five years period was significantly higher in OR clinic than in E clinic, the number of tooth extractions was almost similar. Most of the teeth (70.6%) were extracted for caries complications. The prevalence of the root fractured extracted teeth was 17.93%. In OR clinic, women had more root fractured extracted teeth compared with E clinic, where the number of root fractured extracted teeth was higher in men. Most extracted teeth for root fracture were teeth with prosthetic restorations followed by teeth with root canal treatment and dental fillings. The most extracted teeth for root fracture were maxillary premolars, almost similar for both sexes, followed by mandibular molars. The teeth with least extractions for root fractures were mandibular incisors and mandibular canine.

Etiological Aspects of Noncarious Dental Lesions

PURPOSE

The aim of the present study was to correlate etiological factors with noncarious cervical lesions in a group of patients from Craiova.

MATERIAL AND METHODS

The study was conducted between November 2015 and May 2016 on 50 patients, aged 18-56 years, who addressed to the Oral Rehabilitation Clinic, from the University of Medicine and Pharmacy of Craiova. Patients were divided into two groups: the study group consists of patients who had noncarious cervical dental lesions (NCCLs) and the control group with patients who did not have noncarious cervical lesions. Each patient underwent a clinical examination and completed a questionnaire, referring to eating habits, oral hygiene, vicious habits and personal impressions about the appearance and functionality of his teeth, highlighting the factors involved in the noncarious dental lesions etiology.

RESULTS

The study group consisted of 64% women and 36% men. Noncarious cervical lesions were higher in men (72.22%) compared to women (56.25%). Regarding on the tooth brushing method, it has been noted that 34% of patients used a vertical tooth brushing method, 52% were using a circular brushing method, while 14% were practicing a horizontal tooth brushing method. Cervical sensitivity has been detected in 48% of the patients, against 52% who showed no sensitivity. 62% of the participants did not have bruxism, while nighttime/daytime bruxism was found in 38% of the patients.

CONCLUSIONS

There are several etiological factors correlated with noncarious cervical lesions, among which are: tooth brushing method, bruxism, eating behaviors.

Histopathological aspects of some rare forms of facial basal cell carcinoma

AIM

The main objective of the study was to highlight the histopathological aspects of some rare forms of facial basal cell carcinomas.

PATIENTS, MATERIALS AND METHODS

The 65 selected patients were diagnosed with head basal cell carcinoma (BCC), during 2011-2013, and they underwent surgery. The excised tumor tissue fragments were processed for paraffin embedding and stained with Hematoxylin-Eosin (HE), Masson's trichrome with Aniline Blue, and Alcian Blue-Periodic Acid Schiff (AB-PAS).

RESULTS

The youngest patient was 23 years old, while the oldest was 91 years. The facial BCC there was slightly higher prevalence in males of 34 out of 65 cases. Histopathologically, great varieties of morphological types have been identified in the 65 cases investigated. According to our data, by far the most common are nodular BCCs type, which represented 44.6% from the investigated cases, followed at some distance by morpheiform and superficial subtypes with 13.8% and 10.7%, respectively. The most rare cases of facial BCCs were: cystic, adenoid, fibroepithelial and basal with adnexal differentiation with in one single case each. Relatively rare were the following varieties: pigmented (four cases), combinations of several forms (four cases), metatypical (three cases), keratotic (three cases), and micronodular (two cases).

CONCLUSIONS

Within the limits of this study, the data reported here shown that such a lesional pleomorphism very often requires to make a careful differential diagnosis with a number of other tumor or non-tumor entities.

Radiological and optical coherence tomography aspects in external root resorption

Pathological external root resorption is a process by which the hard tooth substance is lost because of action of different local irritative or systemic factors. Six forms of external root resorption are described: surface external root resorption, inflammatory external root resorption, replacement external root resorption, invasive external cervical root resorption, ankylosis and transient apical breakdown. The objective of the study was to establish the prevalence of the pathological root resorption in a retrospective radiological study, to highlight radiological aspects of external root resorption and to describe optical coherence tomography (OCT) aspects in pathological root resorption. External root resorption prevalence in our study was 17%. Radiological exam was very useful to detect the form of root resorption but also to establish possible etiological factors. The study presents the radiological aspects of some forms of pathological external root resorption highlighted on radiography accompanied by radiolucency of the adjacent bone to resorption lesion (as in inflammatory external root resorption and in invasive cervical root resorption) or as changes of the root form, in which the missing part of the root is replaced by the bone tissue, without radiolucency (as in replacement root resorption). The comparison of the OCT aspects of the physiological root resorption in primary teeth with the OCT aspects of pathological root resorption in permanent teeth showed an obvious difference between the images of the OCT signal of the two types of resorption. The OCT signal from the cement is stronger in pathological root resorption, and the OCT signal from the dentin in teeth with inflammatory external root resorption showed a demineralized dentin with multiple heterogeneities, anfractuosities corresponding to resorption craters, with craze lines in subjacent layers of dentin.

Interrelationship between oral status and histopathological aspects of periodontitis in patients from Craiova, Romania

The aim of the present study was to evaluate the oral status in a group of institutionalized individuals from Craiova, a city in South-Western Romania. Also, another objective of the study was to highlight the clinical, histological and immunohistochemical (IHC) aspects of periodontal disorders in the elderly. The study was performed on 48 institutionalized individuals examined in the Clinic of Dental Prosthetics, Faculty of Dentistry, University of Medicine and Pharmacy of Craiova, Romania, in 2013. The data were collected using medical records and intraoral clinical examination. The data were processed by descriptive statistical analysis. The gingival mucosa samples were harvested from subjects with teeth mobility. The gingival fragments collected were processed through the histological technique of paraffin inclusion. The serial sections were commonly stained with Hematoxylin-Eosin and processed by the IHC technique with anti-CD3, anti-CD45RO and anti-CD20 antibodies. Of the 48 study participants, 20 were males, 28 were females, aged over 56 years old. 66.6% of them had poor oral hygiene, with a mean simplified oral hygiene index (OHI-S) of 1.57, 16 had the generalized periodontitis, three experienced some form of gingival overgrowth at the remaining teeth caused by incorrect fixed prosthesis, and 25 participants presented a form of periodontitis with gingival retraction. Gingival mucosa samples were histologically diagnosed with papillomatosis with discrete parakeratosis and rich chronic inflammatory infiltrate. The IHC reactions for the studied antibodies were different for T- and B-cells, which had different disposition in lamina propria.

Optical coherence tomography applications in tooth wear diagnosis

Dental wear represents an irreversible loss of dental hard tissue under the action of physical, chemical and mechanical factors, excluding dental caries and acute trauma. Four clinical forms of dental wear are described: erosion, attrition, abfraction, and abrasion. Most experts agree that in each clinical form multiple etiological factors are involved, one being predominant. Optical coherence tomography (OCT) is a non-invasive optical method characterized by a micronic resolution. The applications of this type of investigation are multiple in the medical field in recent years, and OCT is gaining a growing importance in dentistry. The study pointed out through OCT imaging for the erosive tooth wear lesion the existence of chemical aggression, with strong demineralization of enamel and dentin. For attrition lesion, OCT images showed the contribution of excessive force and friction movements specific to bruxism. In abfraction, OCT image revealed the importance of the mechanic factor in producing this form of tooth wear and abrasion damage studied may be considered physiological, according to patient age. OCT examination may reveal existing lesions in hard dental tissues for each clinical form and could bring evidence on the mechanisms involved.

Maxillary distomolars: case reports, differential diagnosis and literature review

Supernumerary teeth can be found anywhere in the oral cavity, during deciduous or permanent dentition, in males and females. They are rare, owned to various genetic or environmental factors and usually impacted. This article first reports three cases of young adult patients coming to the office for other reasons than their maxillary distomolars and without any pathology caused by them. The decision of keeping or removing these teeth was made based on other associated factors. The fourth case is one of a 40-year-old partially edentulous male patient, also with a good general health and no other associated condition, having a unilateral maxillary fourth molar; it was small, only partially erupted, with a normal morphology with crown and root and an impacted perpendicular position on the distal face of the third molar. It was extracted because of the periodontal and carious complications that it caused to the third molar facing it. The last reported case is a 64-year-old partially edentulous female patient with a maxillary tooth very similar to a distomolar because of its form and position; it was extracted because it interfered with the new removable partial denture treatment plan. The differential diagnosis between a distomolar and an anatomical variant of a third molar was difficult to make even using panoramic X-ray, also because of a very small inferior third molar. In young patients, distomolars are rather accidentally discovered during radiographic examination; later in life, they can cause both pathological issues and difficulties in diagnosis and prosthetic treatment.

Risk of Dental Caries for Children Aged 4 to 6 in Craiova

Dental caries represent a chronic disease of high prevalence for the human body and is produced by the interaction of a number of predisposing factors throughout the time. Specialized studies in recent years have made some progress with regard of complex interacting factors in the process of developing dental caries in children, but due to the plurifactorial nature of the disease it seems that there is still much to be studied regarding the start, progress and prevention of tooth decay.The aim of the study was to determine the risk of tooth decay in children aged 4 to 6 years in Craiova and the relationship of the main etiopathogenic cariogenic factors.

MATERIAL AND METHODS

The study included a total of 101 children of both sexes, aged 4-6 years, from two kindergartens in Craiova. They filled out questionnaires about food and oral hygiene habits and after that the study protocol included visual clinical examination in according to WHO methodology; determination of dmft index with the analysis of dt, mt and ft component The results were recorded in personal files and were analyzed statistically.

RESULTS

The results of our study were consistent with data from the literature of recent years. So, the highest value of the dmft index (2.52) was at the age group of 6.

CONCLUSIONS

The most significant contribution to the values of carious experience is the number of teeth affected by caries at the expense of obturated ones.

Local cause of gingival overgrowth. Clinical and histological study

The overgrowth, depending on its extension, has multiple effects on the stomatognathic apparatus: functional disorders (impaired speech), difficulty in chewing and aesthetic problems but can cause significant psychological problems. We proposed this study, motivated by the relative increased frequency of the gum outgrowth, its multifactorial etiopathogeny, but especially from the point of view of the specialist practitioner, by the problems that this pathology raises not only for the functionality of the stomatognathic apparatus but also for the facial esthetics, and especially for future therapeutic attitudes needed to solve the existing pathology at this level. We conducted a clinical study and a histological one. For the clinical study, we selected 74 patients who experienced different degrees of gingival outgrowing associated with fillings, dental caries, fixed prostheses, mobile prostheses, orthodontic apparatus. Thirty gingival fragments from patients with gingival outgrowing were processed by paraffin-embedding histological technique and stained with Hematoxylin-Eosin. The morphological results obtained provide the necessary support for understanding the possibility of developing a therapeutic strategy to prevent or minimize the gum outgrowth by administering antibiotic and anti-inflammatory medications associated with medications, which shall cause the apoptosis of the fibroblasts.

Morphological and clinical characteristics of the torus palatinus and torus mandibularis in a sample of young and adults' Romanian people

The oral exostoses are protuberance located on the alveolar surfaces of the jawbones with nodular, flat or pedunculated shape. The purpose of this study was to highlight the variability of the morphological and clinical characteristics of torus palatinus (TP) and torus mandibularis (TM) in a sample of young and adults' Romanian people. The study was conducted on 74 participants examined in Dental Prosthetics Clinic of the Faculty of Dentistry, University of Medicine and Pharmacy of Craiova, Romania, during October-December 2014. The morphological characteristics of the tori were non-metrical evaluated by the standard procedures of the clinical examination. Descriptive statistics only including means, averages and percentage incidence have been used to describe the results. Of the 74 study participants, 31 (41.89%) were males and 43 (55.40%) were females. Six had only TP, seven had only TM and three participants had both TP and TM. The most of the palatal tori had spindle shaped, located in all area of the hard palate The round mandibular tori with big size were located in the area of both premolars, and those with elongate shape were located in the canine-premolars area. The palatal tori were more frequently in women and the frequency of mandibular tori was equally in men and women. Most of the palatal tori had spindle shape and most of the mandibular tori were solitary bilateral.

Prosthetic Treatment Possibilities for Extended Partially Edentulous and Completely Edentulous Patients, Depending on the Clinico-Morphological Characteristics of the Oral Mucosal Substrate

The number of partially and completely edentulous patients requiring removable prosthetic treatment has increased constantly and denture wearers often have an associated oral status pathology. The purpose of this article is to present removable prosthetic treatment options that we chose for the extended partially edentulous and completely edentulous patients who required prosthetic rehabilitation treatment. We conducted this study on 52 extended partially edentulous and completely edentulous patients. We recorded in the examination chart the characteristics of the mucosal membrane covering the denture supporting structure and the peripheral structures and we performed a statistical analysis using Microsoft Excel. The prosthetic treatment phases were individualized according to morphological characteristics of the oral mucosal substrate.

Immunohistochemical aspects of apoptosis in gingival mucosa with papilloma and condyloma acuminata

The oral mucosa is a component of the oral ecosystem, which can be aggressed by corrosion products released from the dental alloys used in prosthetic dentistry therapy. The purpose of this study was to compare the in vivo effect of nickel and copper compounds on the oral mucosa cells, including their ability to induce cell death, by analyzing the cytochrome c (cyt. c) immunohistochemical expression. Gingival mucosa fragments obtained from the subjects with dentures manufactured by nickel or copper casting alloys were processed through the histological technique of paraffin inclusion. The sections obtained were stained by usually histological methods in order to highlight the histopathological lesions and also analyzed using the immunohistochemical technique in order to study the cyt. c expression. The papillomatosis lesions were observed in the gingival mucosa fragments obtained from the subjects with nickel-based alloy dentures and the condyloma acuminata lesions were observed in those obtained from the subjects with copper-based alloy dentures. The cyt. c immunohistochemical expression was different in the epithelial layer of two types of mucosal fragments but it was the same in their lamina propria connective tissue. We can conclude that the two types of metal alloys have different effects on the adjacent gingival mucosa.

Immunoexpression of vascular endothelial growth factor in gingival mucosa with papilloma and condyloma acuminata

The histological changes of the oral mucosa in contact with a metal alloy dentures is one of the current issues widely debated in the literature.

AIM

To highlight the expression of vascular endothelial growth factor (VEGF) in human paraprosthetic gingival mucosa exposed to nickel and copper compounds using the immunohistochemical technique. The selected participants were wearers of fixed dentures made of nickel-based alloys and copper-based alloys. The gingival mucosa fragments were prelevated through excision after removing fixed denture and extraction one of its affected teeth. The gingival mucosa fragments were processed through the histological technique of paraffin inclusion. The paraffin-embedded tissue sections were usually stained with Hematoxylin-Eosin and processed by immunohistochemical technique with VEGF antibody. The gingival mucosa fragments from nickel-based alloys dentures wearers were diagnosed with papilloma and, also, gingival mucosa samples prelevated from copper-based alloys dentures wearers were diagnosed with condyloma acuminata. Immunohistochemical reaction for VEGF was different in the gingival mucosa fragments with papilloma compared with condyloma acuminata samples. In papillomatosis gingival mucosa fragments, VEGF was implicated in principal in vasodilatation and inflammation process, and secondary in angiogenesis. In gingival mucosa fragments with condyloma acuminata, the principal role of VEGF was in angiogenesis and secondary in inflammation.

Heterogeneity of collagen secreting cells in gingival fibrosis--an immunohistochemical assessment and a review of the literature

AIM

In this work, we compared the histological features of the gingival lesions clinically diagnosed as fibrotic overgrowths due to various etiologic factors as well as an immunohistochemical assessment of fibroblasts phenotypic heterogeneity using the specific labeling for vimentin, α-smooth muscle actin (α-SMA) and fibroblast specific protein-1 (FSP1).

MATERIALS AND METHODS

Tissue samples were obtained from 12 patients clinically diagnosed with fibrotic gingival overgrowth, divided in four groups. Fragments of gingiva were processed for paraffin embedding. Serial sections were used for routine staining Hematoxylin-Eosin, trichromic Masson and Goldner-Szekely, and for immunohistochemical reactions to label vimentin, α-SMA and FSP1 using for signal amplification several techniques (EnVision, LSAB, ABC).

RESULTS

Storage of collagen fibers, increase of fibroblast number and frequent presence of inflammatory infiltrate are histological issues of all fibrotic gingival overgrowth. The incidence of granulation tissue varies but the frequency of its presence point the attention to the involvement in collagen metabolism imbalance. Immunostaining for vimentin showed a difference between its expression in samples from different groups. Except the cases of fibrosis induced by orthodontic devices, cells positive for α-SMA were rare. FSP1-positive fibroblasts were the most frequent in all cases from all the groups selected for this study.

CONCLUSIONS

The phenotype of fibroblasts is different in gingival fibrosis in relation to the risk factor, at present the most common being vimentin-positive and FSP1-positive fibroblasts. Myofibroblasts are rare in gingival fibrosis, the most numerous being in local lesions caused by wearing orthodontic devices and in syndromic fibromatosis. Further studies are required to elucidate the manner in which the active fibroblasts are recruited in relation to the etiologic factor of gingival overgrowth.

A case with tumor of left parotid gland and denture stomatitis

The article discuss the case of an edentulous patient presented to the dental clinic for pain and burning sensation of oral mucosa and diagnosed subsequently with oxyphilic adenoma. A 58-year-old patient, with maxillary edentulism, treated with complete denture, presented to the Clinic of Prosthetic Dentistry of the Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, Romania, for pain of oral mucosa and bad stability of denture. The diagnosis of erythematous denture stomatitis as consequence of salivary flow reduction was establish after patient's clinical examination, and by unstimulated sialometry. Clinical exam suggested hyposalivation could be a consequence of a tumor situated at the level of the left parotid gland. The echography confirmed the diagnosis of left parotid gland tumor. The tumor was surgical removed and histopathological exam confirmed oxyphilic adenoma. Education of patient for wearing new denture while maintaining a strict oral hygiene and dealing with low salivary flow was the treatment for denture stomatitis. General dentist has an important role in finding and diagnosing patients with systemic diseases, especially salivary tumors.

Idiopathic gingival hypertrophy--a morphological study and a review of literature

Gingival overgrowth occurs as a response to several drugs, in some systemic diseases, as a consequence of a genetic predisposition or could be idiopathic, the last being less studied. Independently of the etiological factor involved, histological changes are maintained and intensified by the presence of the bacterial plaque.

MATERIAL AND METHODS

Fibrotic mucosa clinically diagnosed with idiopathic hypertrophy was included in paraffin and studied using usual histological stains and immunohistochemical techniques for vimentin, MMP-3 and TIMP-2.

RESULTS

Evaluation of histological changes revealed an unspecific pattern like the thickening of the epithelium, with acanthosis and acantholysis and massive deposition of connective tissue in the lamina propria. Keratinocytes from the areas with acantholysis express MMP-3. In the fibrous areas we noted few fibroblasts and a discrete expression of MMP-3. Extended areas of inflammatory tissue with numerous de novo capillaries were observed among the collagen bundles. Proinflammatory and endothelial cells expressed both MMP-3 and TIMP-2. The last antibody had an intense expression deeper in the epithelium. Our results were discussed in accordance with reference data.

CONCLUSIONS

We conclude that the histological changes observed were not specific for the idiopathic gingival hypertrophy and the imbalance of tissue homeostasis was due to the interaction between keratinocytes and connective cells in the milieu of specific changes induced by the inflammatory conditions.

Morphoclinical aspects of the human paraprostethic gingival mucosa

The multiple and various changes that the human gingival mucosa undergoes when coming into contact with a denture, require a histopathological study correlated with that of clinical manifestations. The highlighting of the histological lesions of the prosthetic field's mucosa is extremely important in the study concerning the tolerance of the oral cavity tissues towards the materials of dentures, because it has been observed that different materials can cause the same type of clinical changes. The clinical research has been carried out having as a basis a group of patients, carriers of fixed dentures made of different materials, the study method consisting in their clinical evaluation. The investigation of microscopic preparations, obtained through drawing mucosa from those patients under study, has been made by using both usual colorations for an overall examination of the tissue architecture, as well as special colorations for pointing out certain structures. The results of the investigation have made clear the fact that the clinical changes of the prosthetic field's mucosa can be adaptable to the denture or can react pathologically to the various possibilities of denture aggression. The histopathological picture of the paraprosthetic mucosa lesions is polymorphous due to the morphofunctional complexity as well as to the reacting capacity of the oral mucosa when interfering with a fixed denture.