The impact of head and neck radiotherapy on the dentine-enamel junction : a systematic review

Radiotherapy is widely used in contemporary head and neck cancer treatment protocols. The ability of head and neck radiotherapy (HNRT) to cause direct radiogenic destruction to the teeth is one of the most controversial topics in the field of oral oncology. Therefore, this systematic review aimed to investigate ionising radiation as an independent factor for physical and chemical changes on the dentine-enamel junction (DEJ), a pivotal dental topography for the onset and progression of radiation-related caries (RRC) and enamel delamination. Systematic searches were conducted on three databases: Scopus, MEDLINE (Via PubMed) and Embase (Elsevier). Laboratory studies evaluating the effects of simulated or in vivo HNRT on the DEJ were included. The GRADE tool adapted for in vitro studies was used to assess the methodological quality. Of the 154 initially selected studies, eight met the inclusion criteria, from which five studies were graded as high quality of evidence, two studies were graded as moderate quality and one as low quality. Two studies did not demonstrate DEJ alterations following HNRT while the other six articles described several organic and inorganic changes in the DEJ of irradiated teeth samples. These radiogenic events were mostly detected through micro and nanoindentation, Raman micro-spectroscopy, confocal microscopy, Western blotting and optical coherence tomography. HNRT may have a negative impact on the physical and chemical aspects of the DEJ, predisposing cancer patients to RRC and enamel delamination

Análise fotoelástica das tensões geradas por transferência em implantes osseointegrados

O objetivo neste estudo foi analisar a tensão gerada em quatro técnicas de transferência utilizadas na implantodontia (Grupo I: transferentes quadrados foram unidos com fio dental e foi depositada resina (Pattern Resin) sobre o fio dental, de modo que unisse os transferentes em monobloco; Grupo II: transferentes quadrados foram unidos com fio dental e foi depositada resina (Patter Resin) sobre o fio, assim como no Grupo I, porém esse monobloco foi seccionado e unido novamente; Grupo III:transferentes quadrados foram unidos com uma haste metálica rígida e Grupo IV: transferentes quadrados foram unidos com uma haste metálica semirrígida). Foi utilizado silicone para confecção dos moldes e resina fotoelástica para confecção dos modelos e resina Patter Resin para união dos transferentes de todos os grupos. A análise fotoelástica foi realizada em polariscópio em quatro modelos para cada grupo, totalizando dezesseis modelos. Com esse trabalho concluímos que a melhor técnica de transferência é a técnica de união dos transferentes por haste metálica rígida (técnica que gera menor tensão na área dos implantes), e a técnica menos indicada por gerar a maior tensão na área dos implantes é a de união dos transferentes por fio dental e resina em monobloco, devida a contração de polimerização da resina.The objective of the research is to analyze the tension generated in four different techniques used in implantology (Group I: squared transfer were united with floss and was deposited resin (Pattern Resin) about flossing, so join the transferees monobloc group II: squared transfer were united with floss and was deposited resin (resin Patter) on the wire, as in group I, but this monoblock was sectioned and reunited; group III: squared transfer were united with a rigid metal rod and group IV: squared transfer were united with a semi-rigid metal rod). Was used for making silicone molds and resin for making photoelastic models and resin Resin Patter for transferees union of all groups. The photoelastic analysis was performed with the aid of a polarioscópio four models of each group, a total of sixteen models. With this work we conclude that the best transfer technique is the technique of joining by transferents rigid metal rod (technique that generates less tension in the implant), and the technique less suitable for generating the higher voltage area of the implants is the union of transferees by flossing and resin monobloc, due to polymerization shrinkage of the resi

Impact of intravenous bisphosphonated in cementum and periodontal ligament of cancer patients

Orientadores: Mario Fernando de Goes, Alan Roger dos Santos SilvaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Bisfosfonatos (BFFs) são medicamentos que reduzem a habilidade dos osteoclastos induzirem reabsorção óssea e, consequentemente, aprimoram o equilíbrio entre reabsorção e formação, sendo frequentemente prescritos por via oral (direcionados para o tratamento de doenças do metabolismo ósseo como a osteoporose e a doença de Paget) ou intravenosa (para tratamento de metástases ósseas e mieloma múltiplo). Apesar de sua comprovada eficácia no tratamento das doenças supramencionadas, o uso dos BFFs está associado a uma série de complicações, entre elas a osteonecrose induzida por BFFs. Recentemente, o uso dos BFFs também foi relacionado a alterações estruturais dos dentes, incluindo hipercementose e espessamento do espaço correspondente ao ligamento periodontal (LP). Portanto, o objetivo desse estudo foi testar a hipótese nula de que o uso intravenoso (IV) de BFFs não é capaz de alterar a micromorfologia do cemento e do ligamento periodontal de pacientes oncológicos. Com esta finalidade, foram utilizados 32 dentes; 16 oriundos de pacientes que fizeram uso de BFFs IV (grupo teste) e 16 de pacientes com câncer não tratados por BFFs (grupo controle). Os dentes foram posteriormente separados em 2 subgrupos de acordo com o processamento histológico e técnicas de investigação utilizadas:a) análise da espessura de cemento em 3 diferentes regiões (apical, média e cervical) por microscopia de luz polarizada (n=16, 8 grupo teste / 8 grupo controle) e b) análise da expressão imunoistoquímica do anticorpo anti-periostin em remanescentes do LP, contagem de fibroblastos no LP e do número de linhas incrementais de cemento (n=16, 8 grupo teste / 8 grupo controle). Não foi possível observar diferenças estatisticamente significativas entre os grupos quanto à micromorfologia do cemento [número de linhas incrementais (p=0.51)], número de fibroblastos no LP (p=0.56), espessura do cemento nas 3 regiões analisadas (p= 0.06; p=0.16 e p=0.18, respectivamente), expressão de periostin no LP entre os grupos (p=0.68) e presença de inflamação (p=0.59). A hipótese nula testada foi aceita e os resultados deste estudo sugerem que o uso de BFF IV não é capaz de causar alterações na micromorfologia do cemento ou do LP de pacientes oncológicosAbstract: Bisphosphonates (BFFs) are medications, which reduce the ability of osteoclasts to induce bone resorption and consequently improve the balance between resorption and formation, being often prescribed orally (for the treatment of metabolic bone diseases, such as osteoporosis and Paget's disease), or intravenously (for the treatment of bone metastases and multiple myeloma). Despite its proven efficacy in the treatment of such diseases, the use of BPs is associated with a series of complications, including BP-related osteonecrosis of the jaws. Recently, the use of BPs was also associated to structural changes of teeth, including hypercementosis and thickening of the space corresponding to the periodontal ligament (PL). Therefore, the aim of this study was to test the null hypothesis that intravenous (IV) BPs are not able to change the micromorphology of cementum and PL of cancer patients. For this purpose, 32 teeth were analyzed, of which 16 were obtained from patients who received IV BPs (test group) and 16 from cancer patients naive to BPs (control group). Teeth were further divided into 2 subgroups according to histological processing and research techniques used: a) analysis of the thickness of cementum in 3 different regions (apical, middle and cervical thirds) by polarized light microscopy (n=16; 8 test group / 8 control group) and b) immunohistochemical analysis of the expression of anti-periostin antibody in the remaining of PL, number of fibroblasts in the PL and number of incremental lines of cementum (n=16; 8 test group / 8 control group). When comparing test and control group samples, it was not possible to observe statistically significant differences in the micromorphology of the cementum [number of incremental lines (p=0.51)], number of fibroblasts present in the PL (p=0.56), thickness of cement in any of the three studied areas (p=0.06; p=0.16; p=0.18, respectively), periostin expression in the PL between the groups (p=0.68) and presence of inflammation (p=0.59).The null hypothesis tested was accepted and the results of this study suggest that the use of IV BPs is not able to change the micromorphology of the cementum or PL of cancer patientsMestradoPatologiaMestra em Estomatopatologia33003033009P4CAPE

Examining tumor modulating effects of photobiomodulation therapy on head and neck squamous cell carcinomas

Photobiomodulation (PBM) therapy is an effective method for preventing and managing oral mucositis (OM) in head and neck squamous cell carcinoma (HNSCC) patients undergoing radiotherapy alone or in combination with chemotherapy. However, the potential effects of PBM therapy on premalignant and malignant cells eventually present in the treatment site are yet unknown. The aim of this systematic review was to analyze the effects of PBM therapy on HNSCC. A literature search was conducted in four indexed databases as follows: MEDLINE/PubMed, EMBASE, Web of Science, and Scopus. The databases were reviewed for papers published up to and including in October 2018. In vitro and in vivo studies that investigated the effects of PBM therapy on HNSCC were selected. From the 852 initially gathered studies, 15 met the inclusion criteria (13 in vitro and 2 in vivo). Only three in vitro studies were noted to have a low risk of bias. The included data demonstrated wide variations of study designs, PBM therapy protocols, and study outcomes. Cell proliferation and viability were the primary evaluation outcome in the in vitro studies. Of the 13 in vitro studies, seven noted a positive effect of PBM therapy on inhibiting or preventing an effect on HNSCC tumor cells, while six studies saw increased proliferation. One in vivo study reported increased oral SCC (OSCC) progression, while the other observed reduced tumor progression. Overall, the data from the studies included in the present systematic review do not support a clear conclusion about the effects of PBM therapy on HNSCC cells18716211637CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPNão tem2018/02233-6This work was in part supported by the Brazilian National Council for Scientific and Technological Development (CNPq post graduate scholarship). Manoela Domingues Martins and Alan Roger Santos-Silva are research fellows funded by the Brazilian National Council for Scientific and Technological Development (CNPq). The authors would like to gratefully acknowledge the financial support of the São Paulo Research Foundation (FAPESP) (process number 2018/02233-6

Structural analysis of enamel in teeth from head-and-neck cancer patients who underwent radiotherapy

CAPES - COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL E NÍVEL SUPERIORCNPQ - CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOTo analyze macroscopic, microscopic, and ultra structural aspects of enamel from head-and-neck cancer patients submitted to radiotherapy. Materials and Methods: Twenty sound extracted permanent molars were used and divided into 2 groups. The experimental group consisted of 10 molars from head-and-neck cancer patients submitted to radiotherapy with total doses that ranged from 50 to 70 Gy. Ten molars from patients who did not receive radiotherapy were matched with experimental-group samples by anatomic tooth group and comprised the control group. To perform a macroscopic analysis, standardized photos of different enamel faces were taken with a camera. Teeth were subjected to longitudinal cuts and hand polished to a final thickness of 0.1 mm. Enamel was analyzed under polarized light microscopy, and optical retardation values of birefrin-gence were calculated in cervical, cusp, and occlusal pit areas. Subsequently, the same enamel areas were analyzed by scanning electron microscopy. Data from optical retardation values were statistically analyzed by 2-way ANOVA and Fisher's test (alpha < 0.05). Results: No macroscopic differences were observed between the irradiated and control groups. Polarized light microscopy analysis revealed that cervical enamel exhibited darker areas characterized by discrete birefringence patterns compared to the control enamel. Optical retardation values were only significantly different in the cervical enamel of the irradiated and control groups (p < 0.0001). Scanning electron microscopy analysis revealed more evident interprismatic spaces in the cervical and outer cusp enamel of irradiated samples. Conclusions: Head-and-neck radiotherapy reduced optical retardation values of birefringence in cervical enamel, and the interprismatic spaces became more evident. (C) 2017 S. Karger AG, BaselTo analyze macroscopic, microscopic, and ultra structural aspects of enamel from head-and-neck cancer patients submitted to radiotherapy. Materials and Methods: Twenty sound extracted permanent molars were used and divided into 2 groups. The experimental group consisted of 10 molars from head-and-neck cancer patients submitted to radiotherapy with total doses that ranged from 50 to 70 Gy. Ten molars from patients who did not receive radiotherapy were matched with experimental-group samples by anatomic tooth group and comprised the control group. To perform a macroscopic analysis, standardized photos of different enamel faces were taken with a camera. Teeth were subjected to longitudinal cuts and hand polished to a final thickness of 0.1 mm. Enamel was analyzed under polarized light microscopy, and optical retardation values of birefrin-gence were calculated in cervical, cusp, and occlusal pit areas. Subsequently, the same enamel areas were analyzed by scanning electron microscopy. Data from optical retardation values were statistically analyzed by 2-way ANOVA and Fisher's test (alpha < 0.05). Results: No macroscopic differences were observed between the irradiated and control groups. Polarized light microscopy analysis revealed that cervical enamel exhibited darker areas characterized by discrete birefringence patterns compared to the control enamel. Optical retardation values were only significantly different in the cervical enamel of the irradiated and control groups (p < 0.0001). Scanning electron microscopy analysis revealed more evident interprismatic spaces in the cervical and outer cusp enamel of irradiated samples. Conclusions: Head-and-neck radiotherapy reduced optical retardation values of birefringence in cervical enamel, and the interprismatic spaces became more evidentKarger512119128CAPES - COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL E NÍVEL SUPERIORCNPQ - CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOCAPES - COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL E NÍVEL SUPERIORCNPQ - CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOsem informação31065013/18402-8; 16/22059-5SuiçaCaries researchCaries resBase

Is photobiomodulation therapy effective in reducing pain caused by toxicities related to head and neck cancer treatment? : a systematic review

Photobiomodulation therapy (PBMT) has been considered an effective method for preventing and managing certain cancer-related toxicities in head and neck cancer (HNC) patients treated with radiotherapy and chemotherapy. However, the potential effects of PBMT on pain control and analgesia resulting from these toxicities is still controversial. The aim of this systematic review was to compile available evidence of the effects of PMBT on pain control and reduced use of analgesics in HNC patients. We searched three indexed databases: MEDLINE/PubMed, Embase, and Scopus. The databases were reviewed up to and including December 2018. Only human clinical studies in English language were selected. Information was only available for mucositis and radiodermatitis. Fifteen out of 1112 studies met the inclusion criteria (14 for oral mucositis (OM) and 1 for radiodermatitis). From the 14 studies involving the prevention and treatment of OM, 10 had the study subjects compared to a placebo group. Of these 10 studies, all but 1 showed statistically significant difference related to pain control favoring the PBMT group. The study that compared PBMT with other treatment modality showed better results in pain control with PBMT. It appears that PBMT application frequency and potency impact on pain control. The only study involving the prevention and treatment of radiodermatitis was compared to placebo arm and showed statistically significant difference related to pain control favoring the PBMT group. Seven studies compared the need of analgesic medication between PBMT and placebo groups. Of these, five studies showed that the use of analgesic medication was significantly higher in the placebo group. The current evidence supports that PBMT is effective in pain control resulting from OM and radiodermatitis and may also reduce the need for analgesics. The evidence is not yet available of the effects of PBMT in other HNC treatment-related toxicities271140434054CNPQ - Conselho Nacional de Desenvolvimento Científico e TecnológicoFAPESP – Fundação de Amparo à Pesquisa Do Estado De São PauloNão tem2018/02233-6; 2013/18402-8; 2012/06138-

Intravenous bisphosphonate therapy does not thicken cementum or change periodontal ligaments of cancer patients

FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOCAPES - COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL E NÍVEL SUPERIORTo test the hypothesis that intravenous (IV) bisphosphonate (BP) therapy thickens or alters the micromorphology of cementum and periodontal ligament (PDL) in cancer patients. Study Design. Thirty-two teeth extracted from 24 cancer patients and separated into test (patients who have undergone IV BP therapy, n = 16) and control (patients naive to BP therapy, n = 16) groups were studied. Cementum thickness was measured in 3 different areas of the dental root with polarized light microscopy. PDL was assessed by optical light microscopy and the immunohistochemical expression of periostin. Results. No significant difference was detected in cementum thickness (apical, P = .06; medium, P = .16; cervical, P = .18) between groups. The numbers of fibroblasts in PDL (P = .56), incremental lines of cementum (P = .51) and the immunohistochemical patterns of periostin expression in PDL (P = .68) did not differ between groups. Conclusion. IV BP therapy does not thicken cementum or change the micromorphology of PDL.To test the hypothesis that intravenous (IV) bisphosphonate (BP) therapy thickens or alters the micromorphology of cementum and periodontal ligament (PDL) in cancer patients. Thirty-two teeth extracted from 24 cancer patients and separated into test (patients who have undergone IV BP therapy, n = 16) and control (patients naive to BP therapy, n = 16) groups were studied. Cementum thickness was measured in 3 different areas of the dental root with polarized light microscopy. PDL was assessed by optical light microscopy and the immunohistochemical expression of periostin. No significant difference was detected in cementum thickness (apical, P = .06; medium, P = .16; cervical, P = .18) between groups. The numbers of fibroblasts in PDL (P = .56), incremental lines of cementum (P = .51) and the immunohistochemical patterns of periostin expression in PDL (P = .68) did not differ between groups. IV BP therapy does not thicken cementum or change the micromorphology of PDLElsevier1235591599FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOCAPES - COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL E NÍVEL SUPERIORFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOCAPES - COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL E NÍVEL SUPERIOR2013/00429-7; 2013/18402-8; 2012/06138-133003033009 P4New York, N

Prognostic outcomes of oral squamous cell carcinoma derived from proliferative verrucous leukoplakia: A systematic review.

OBJECTIVE: This study aimed to evaluate prognostic outcomes of PVL-derived oral squamous cell carcinomas (P-OSCC) based on recurrence, new primary tumour, metastasis and survival information. STUDY DESIGN: Five databases and grey literature were searched electronically with the following main keywords (proliferative verrucous leukoplakia, squamous cell carcinoma and malignant transformation) to answer the following review question: &apos;Are survival outcomes for P-OSCC worse?&apos; based on the PECOS principle. The Joanna Briggs Institute Critical Appraisal tool was used to identify possible biases and assess the quality of each of the primary studies. RESULTS: A total of 21 articles met the inclusion criteria, and the results of this systematic review suggest that P-OSCC can recur and generate new primary tumours; however, metastases are rare. Thus, most patients remain alive for an average period of 5 years. CONCLUSION: Apparently, P-OSCC has better clinical prognostic characteristics than conventional OSCC. There is a lack of information on the main prognostic outcomes of P-OSCC; therefore, specific studies must be performed to achieve a better comparison between P-OSCC and conventional OSCC progression

Tumor safety and side effects of photobiomodulation therapy used for prevention and management of cancer treatment toxicities : a systematic review

Photobiomodulation therapy (PBMT), also known as low-level laser therapy (LLLT), has been increasingly used for the treatment of toxicities related to cancer treatment. One of the challenges for the universal acceptance of PBMT use in cancer patients is whether or not there is a potential for the light to stimulate the growth of residual malignant cells that evaded oncologic treatment, increasing the risk for tumor recurrences and development of a second primary tumor. Current science suggests promising effects of PBMT in the prevention and treatment of breast cancer-related lymphedema and oral mucositis, among other cancer treatment toxicities. Nevertheless, this seems to be the first systematic review to analyze the safety of the use of PBMT for the management of cancer-related toxicities. Scopus, MEDLINE/PubMed, and Embase were searched electronically. A total of 27 articles met the search criteria. Selected studies included the use of PBMT for prevention and treatment of oral mucositis, lymphedema, radiodermatitis, and peripheral neuropathy. Most studies showed that no side effects were observed with the use of PBMT. The results of this systematic review, based on current literature, suggest that the use of PBMT in the prevention and management of cancer treatment toxicities does not lead to the development of tumor safety issues932128CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPnão tem2018/02233-6; 2018/04657-