Immunoflogosi e declino cognitivo dell'anziano. Contributo delle infezioni batteriche croniche: il modello umano della parodontite.

La parodontite (PD) è un'infezione periferica polimicrobica ad elevata prevalenza, associata a batteri anaerobi gram-. Nella PD l'equilibrio tra batteri e risposta dell'ospite è alterato, risultando in un'infiammazione incontrollata caratterizzata da alti livelli di mediatori infiammatori (IL-1, IL-6, IL-17, TNF-a) e bassi livelli di molecole anti-infiammatorie (IL-10). Localmente, tali molecole interagiscono amplificando la flogosi ed attivando i meccanismi responsabili della distruzione tissutale. Inoltre, nei pazienti con PD, chemochine (IL-8, Monocyte chemotactic protein-1 (MCP-1) e citochine (IL-1ß, IL-6, IL-17, TNF- a) infiammatorie sono elevate anche nel plasma, contribuendo al carico infiammatorio sistemico ed a potenziali effetti sistemici. I dati circa l'associazione della PD con le patologie neurodegenerative sono scarsi, tuttavia essa sembra plausibile sia da un punto di vista epidemiologico che biologico considerato il contributo alla flogosi sistemica/encefalica, l'incremento di citochine nel cervello evocato dalla stimolazione delle fibre nervose trigeminali, i prodotti batterici e/o i batteri stessi, alcuni dei quali sono capaci di invadere il sistema nervoso centrale e sono stati riscontrati in misura maggiore nei campioni di M. di Alzheimer rispetto ai controlli. Lo scopo del presente lavoro è quello di cercare di chiarire il ruolo ed i meccanismi attraverso cui le infezioni croniche possono contribuire all'insorgenza e/o alla progressione di malattie croniche complesse che caratterizzano l'invecchiamento patologico, in particolare il declino cognitivo e le patologie neurodegenerative. A tale scopo, è stato utilizzato, come modello umano di infezione cronica, la parodontite: condizione clinica ad elevata prevalenza caratterizzata da processi distruttivi a carico dei tessuti parodontali, ad eziologia polimicrobica (gram negativi, anaerobi) e patogenesi infiammatoria. Nel setting clinico su tale obiettivo, sono stati reclutati pazienti affetti solo da parodontite i cui dati sono stati utilizzati come controllo nella comparazione con gli analoghi dati dei pazienti con diversi gradi di impairment cognitivo. In particolare è stato analizzato il profilo proteomico salivare dei pazienti con la tecnologia SELDI-TOF-MS (Surface-Enhanced Laser Desorption/Ionization Time-Of-Flight Mass Spectrometry) che permette di eseguire l’analisi proteomica di piccole quantità di campioni biologici mediante la misurazione del rapporto massa/carica (m/z) delle diverse molecole proteiche, al fine di chiarire i meccanismi di interferenza reciproca ditali condizioni e potenzialmente individuare dei biomarkers utili alla loro caratterizzazione clinico-prognostica. I parametri clinici rilevati hanno evidenziato un significativo aumento degli indici di placca e di sanguinamento al sondaggio nel gruppo di studio (p <0,05), il che potrebbe essere giustificato dalla minore abilità e frequenza nell’eseguire una normale igiene orale. A fronte di ciò, non si è accertata significatività statistica nelle differenze per gli altri parametri parodontali clinici; ciò lascia, verosimilmente, supporre che lo status parodontale non differisce in maniera sostanziale nei due gruppi. L’analisi proteomica ha mostrato 10 picchi espressi in maniera significativamente diversa nella saliva del gruppo di studio rispetto ai controlli. L’analisi CART non è, tuttavia, riuscita a costruire un albero classificativo valido (sensibilità 8%, specificità 12%).Periodontitis is a chronic infectious disease involving gingival tissues, the periodontal ligament and the alveolar bone. It is accompanied by increased low grade inflammation and transient bacteremia. Periodontitis is caused by microorganisms that adhere to and grow on the tooth's surfaces, along with an overly aggressive immune response against these microorganisms. Its association with neurodegenerative disease is still unclear. A possible relationship seems to be related to an increase of cytokines production (IL-1, IL-6, IL-17, TNF-a) in periodontal ligament and the presence of oral microorganisms that may increase the encephalopathy. Current knowledge on the association between periodontitis and encephalopathy is mainly based on small comparative and treatment studies. The aim of the present paper was to investigate the role of periodontitis (a chronic human infection) in neurodegenerative disorders, e.g. Alzheimer. In particular, the presence of markers in saliva by the surface enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS) technology was investigated. SELDI-TOF-MS allows the generation of an accurate protein profile from minimal amounts of biological samples and may produce proteomic profile of saliva, recording all saliva components modification in patients. Clinical parameters measured showed a significant increase in the indices of plaque and bleeding on probing in the study group (p <0.05), which could be justified by the lower frequency and ability to perform a normal oral hygiene. Against this background, it was not found statistically significant differences in other clinical periodontal parameters; thus it seems likely to assume that the periodontal status did not differ substantially between the two groups. Proteomic analysis showed 10 peaks expressed in a manner significantly different in the saliva of the study group compared to controls. However, the CART analysis was not able to build a valid classification tree (sensitivity 8%, specificity 12%)

Expansion of permanent first molars with rapid maxillary expansion appliance anchored on primary second molars

To evaluate how the amount of expansion of the primary second molars, the patient?s age, and the skeletal maturation stage influence the amount of expansion at the level of the permanent first molars. Fifty-five patients aged between 6 and 11 years with a cervical vertebral maturation stage of CS1 or CS2 were retrospectively selected. The intermolar width was measured before and after expansion to evaluate the amount of expansion achieved at the level of the primary second molars and the permanent first molars. Stepwise multiple linear regression was used to evaluate how the amount of primary molars expansion, the patient?s age, and the cervical vertebral maturation stage predict the amount of permanent molar expansion. A significant regression equation was found, and for every 1 mm of primary molar expansion, 0.91 mm of permanent molar expansion can be expected. An age between 6 and 11 years and the CS1 or CS2 skeletal maturation stage were not significant predictors of permanent molar expansion. A rapid maxillary expansion appliance anchored on primary second molars is effective in expanding the permanent molars to correct a transverse maxillary deficiency in prepubertal patients, transferring the risks associated with the large forces used to the primary teeth

Efecto de la prolongación de la máscara facial en el desarrollo de los caninos maxilares impactados: un estudio retrospectivo.

Objective: The aim of the present study was to evaluate if maxillary protraction with facemask increases the risk of maxillary canine impaction. Materials and method: The records of 76 skeletal Class III subjects with a cervical vertebral maturation stage between CS1 and CS3 and a displaced maxillary canine were retrospectively collected. Intraoral photographs, orthopantomography and lateral cephalograms were collected, and patients were divided into three groups depending on the type of treatment received – a Rapid Palatal Expander (RPE), a RPE in conjunction with a facemask (RPE-FM), or a Class III functional appliance (FA). The patient’s records were used to determine if the maxillary canines were correctly erupted after that phase of treatment. A binary logistic regression was used to evaluate the effect of treatment modality and skeletal maturation stage on the chance of maxillary canine impaction. Results: No effect of the three different treatment modalities and of the skeletal maturation stage on the risk of canine impaction was observed. Conclusions: The protraction facemask can be used in growing skeletal Class III subjects without increasing the risks of maxillary canine displacement.El objetivo del presente estudio fue evaluar si la protracción maxilar con mascarilla aumenta el riesgo de impactación canina maxilar. Materiales y método: se recogieron retrospectivamente los registros de 76 sujetos esqueléticos de Clase III con una etapa de maduración vertebral cervical entre CS1 y CS3 y un canino maxilar desplazado. Se recogieron fotografías intraorales, ortopantomografía y cefalogramas laterales, y los pacientes se dividieron en tres grupos según el tipo de tratamiento recibido: un expansor palatino rápido (RPE), un RPE junto con una máscara facial (RPE-FM) o un aparato funcional (FA) clase III. Los registros del paciente se usaron para determinar si los caninos maxilares entraron en erupción correctamente después de esa fase del tratamiento. Se utilizó una regresión logística binaria para evaluar el efecto de la modalidad de tratamiento y la etapa de maduración esquelética sobre la posibilidad de impactación canina maxilar. Resultados: no se observó ningún efecto de las tres modalidades de tratamiento diferentes y de la etapa de maduración esquelética sobre el riesgo de impactación canina. Conclusiones: la mascarilla de protracción se puede usar en sujetos esqueléticos clase III en crecimiento sin aumentar los riesgos de desplazamiento canino maxilar

Long-term effect on adenoid dimensions and craniocervical angulation after maxillary expansion with fixed or functional appliances

Maxillary expansion is a common orthodontic procedure that could have a positive effect also on airway patency. The aim of the present study was to evaluate the long-term effects of rapid maxillary expansion (RME) on nasopharyngeal area and cranio-cervic

Taxonomic Analysis of Oral Microbiome during Orthodontic Treatment

Background: Orthodontic appliances induce significant changes in the oral microbiome, but this shift in microbial composition has not been well established by the available evidence yet. Objectives: To perform a systematic review of existing literature in order to assess the taxonomic microbial changes in orthodontic patients during Fixed Appliance Treatment (FAT) and Clear Aligner Treatment (CAT), using next-generation sequencing (NGS) technique of the bacterial 16S rRNA gene. Search Methods and Selection Criteria. The search for articles was carried out in PubMed, including articles published in English until May 2021. They included every human study report potentially relevant to the review. Data Collection and Analysis. After duplicate study selection and data extraction procedures according to the PICOS scheme, the methodological quality of the included papers was assessed by the Swedish Council on Technology Assessment in Health Care Criteria for Grading Assessed Studies (SBU) method. Results: The initial search identified 393 articles, 74 of which were selected by title and abstract. After full-text reading, six articles were selected according to inclusion criteria. The evidence quality for all the studies was moderate. Conclusions: Orthodontic treatment seems to transiently affect the composition of subgingival microbiome, although not salivary, maintaining a stable microbial diversity. Different results were found in the shift of microbiome between plaque and saliva, depending on the type of orthodontic treatment. This review should be interpreted with some caution because of the number, quality, and heterogeneity of the included studies

Mechanical Behavior of PET-G Tooth Aligners Under Cyclic Loading

Invisible aligners are medical devices, which allow repositioning of teeth through a treatment designed by the orthodontists. During this orthodontic treatment, patients use several aligners each for a couple of weeks. The aligner will apply a system of forces on the teeth to shift them to desired position. Since aligners exert forces thanks to their particular shape, it is important that during lifetime's service they do not undergo significant deformations. This research aims to study the mechanical behavior of invisible aligners made by polyethylene terephthalate-glycol (PET-G), which is one of most used the plastic materials to produce such devices. In this study, cyclic compression tests in atmospheric environment (∼25°C) as well as in the presence of saliva (to simulate intraoral environment) were performed. The mechanical behavior of aligners with two different thicknesses (0.75 and 0.88 mm) was studied. In particular, each aligner was subjected to 22500 load cycles from 0 to 50 N. The chosen number of load cycles simulates the average load history to which an aligner is subjected during its lifetime. The tests were performed on a testing machine, using a hard resin dental cast properly fixed to the machine. Analysis of the results shows that the stiffness of the aligners increases during the cyclic test. In particular, a gradual reduction of the crosshead displacement was observed during the test, highlighting the occurrence of cyclic hardening phenomena. It was also found that the aligners show a residual strain recovery after removing the applied load. Moreover, in the analyzed range of load rate, the aligners show a low tendency to accumulate residual strains as loading cycles progress

Determinants of maxillary canine impaction : retrospective clinical and radiographic study

The aim of this study is to evaluate determinants of maxillary canine impaction taking into account both canine position related variables and the pattern of facial growth. A retrospective clinical and radiographic analysis was carried out on 109 patients aged between 9 and 10 years at the time of first evaluation. At baseline, SN-GoMe angle, the interincisal angle, the canine angle ? and the canine distance d were used to characterize canine location and vertical facial growth. At the end of a two years follow up period the eruption state of each canine of each patient was recorded and accordingly classified as erupted or impacted on a clinical and radiographic basis. Univariate and multivariate statistical analyses were performed, including correlation among the studied variables and principal components analysis; several machine learning methods were also used in order to built a predictive model. At the end of the two years follow up period after the first examination, 54 (24.77%) canines were classified as impacted. Except for Angle ? values, there were no statistically significant differences between impacted and erupted canines. The studied variables were not significantly correlated, except for the SN-GoMe Angle and the distance d in the impacted canine group and the angle ? and the distance d in erupted canines group. All variables, except for SN-GoMe Angle in erupted canines, have a partial communality with the first two principal components greater than 50%. Among the learning machine methods tested to classify data, the best performance was obtained by the random forest method, with an overall accuracy in predicting canine eruption of 88.3%. The studied determinants are easy to perform measurements on 2D routinely executed radiographic images; they seems independently related to canine impaction and have reliable accuracy in predicting maxillary canine eruption

Changes in pharyngeal aerobic microflora in oral breathers after palatal rapid expansion

BACKGROUND: The purpose of this study was to investigate in oral breathing children the qualitative and quantitative effects on aerobic and facultatively anaerobic oropharyngeal microflora of respiratory function improved by rapid palatal expansion (RPE). METHODS: In an open clinical trial, we studied 50 oral breathers, aged 8 to 14 years and suffering from both maxillary constriction and posterior cross-bite. At baseline, patients were examined by a single otorhinolaryngologist (ENT), confirming nasal obstruction in all subjects by posterior rhino-manometric test. Patients were evaluated three times by oropharyngeal swabs:1) at baseline (T = 0); 2) after palatal spreading out (T = 1); and 3) at the end of RPE treatment (T = 2). With regard to the microbiological aspect, the most common and potentially pathogenic oral microrganisms (i.e. Streptococcus pyogenes, Diplococcus pneumoniae, Staphylococcus aureus, Haemophilus spp, Branhamella catarrhalis, Klebsiella pneumoniae, Candida albicans) were specifically detected in proper culture plates, isolated colonies were identified by means of biochemical tests and counted by calibrated loop. The data were analyzed by means of the following tests: Chi-square test, Fisher's exact test and Wilcoxon's test. RESULTS: After the use of RME there was a statistically significant decrease of Staphylococcus aureus stock at CFU/mLat T1(P = 0.0005; Z = -3,455 by Wilcoxon Rank test) and T2 (P < 0.0001; Z = -4,512 by Wilcoxon Rank test) vs T0. No significant changes were found for the other examined microrganisms. CONCLUSION: Our data suggest that RPE therapy in oral breathers may strongly reduce the pathogenic aerobic and facultatively anaerobic microflora in the oral pharynx after a normalization of the upper airways function, and may reduce the risk of respiratory infections

Post-orthodontic position of lower incisors and gingival recession : a retrospective study

To evaluate if changes in lower incisor position following orthodontic treatment are correlated with development of gingival recessions. Pre- and post-treatment digital models and lateral cephalograms of 22 subjects were collected retrospectively. The clinical crown length, gingival scallop, and papilla height of the central lower incisor were measured along with the cephalometric incisor?s inclination, the distance from the mandibular plane, and the distance between the Infradentale and Menton points. Statistical correlations between gingival and cephalometric variables were studied. In addition, two groups were defined based on the post-treatment incisor inclination value (?normal? or ?proclined?) and compared. The incisor inclination was correlated with the change in gingival scallop and papilla height. Moreover, there was a statistically significant difference in clinical crown height and gingival scallop between the ?normal? group and the ?proclined? group. Changes in lower incisor position, especially an excessive proclination, after orthodontic treatment may play a role in the development of gingival recession

Report of a case of discoid lupus erythematosus localised to the oral cavity: immunofluorescence findings.

Discoid Lupus Erythematosus (DLE) is a chronic disease with a typical cutaneous involvement. This pathology rarely involves mucosa: oral cavity is interested in 20% of DLE patients. We describe a case of oral DLE in a 50-year-old woman with an anamnesis for autoimmune disorders. This study shows the helpful role of immunofluorescence in the diagnosis of autoimmune diseases. The first diagnostic step was the clinical observation of the oral mucosa: the lesion area was erythematous, athrophic and hyperkeratotic. The patient then underwent laboratory examination. We utilized human epithelial cells (Hep-2010) for Indirect Immuno-Fluorescence (IIF). Moreover, the biopsy site for Direct Immuno-Fluorescence (DIF) and histopathological analysis was the untreated oral lesion. IIF detected an increase of Anti-Nuclear Antibody (ANA) and positivity for SSA-RO. By DIF, we observed IgG/IgA/fibrinogen along basal layer. Multiple biopsies reported signs of chronic basal damage. Steroid systemic therapy induced a considerable lesion regression. We suggest the use of immunofluorescence with the integration of further data to improve diagnosis of rare diseases and to establish a suitable therapy