Periodontal and biochemical bone metabolism assessment on a chronic oral anticoagulation population treated with dicoumarins

The aim is to evaluate periodontal alteration and biochemical markers associated with bone turnover in chronic oral with dicoumarins anticoagulant treatment patients. 80 patients treated with oral anticoagulants were divided into 2 cohort: Group A (n=36) 6 month to 1 year with anticoagulant treatment and Group B (n=44) > 2 years with anticoagulant treatment. Clinical evaluation included: Clinical attachment level (CAL), plaque index (PI) and gingival index (GI). Analytically biochemical parameters of bone remodeling (calcium and phosphorus), formation (total acid phosphatase, alkaline phosphatase and osteocalcin) and resorption (tartrate-resistant acid phosphatase and beta-crosslaps) were evaluated. High values of PI (67-100%) especially in men and in Group B were observed. Men with anticoagulation treatment length showed an increased GI (49.167 vs 78.083) while Group B women showed a decreased GI in comparison with Group A (59.389 vs 42.120). Women presented a greater average CAL than men as well as Group B vs Group A but without statistical significance. All biochemical markers were decreased respect to values of general population. Osteocalcin in GroupB women showed a statistically significant outcome vs GroupA (p=0.004). Acid phosphatase (total and tartrate-resistant) has a slight increase in Group B women versus Group A, and Beta-crosslap showed lower values in Group A men than Group B and slightly lower in Group A women versus Group B, without statistical significance. Patients showed a slight to moderate degree of periodontal affectation, especially gingivitis related to bacterial plaque. Periodontal disorders tended to be more severe in Group B. While bone remodeling showed an overall decrease with greater affectation of bone neoformation phenomena, bone destruction tended to recover and normalize in time

Dental extraction in patients rece iving dual antiplatelet therapy

Background: Dual antiplatelet therapy consists of administering antiplatelet (antiaggregant) drugs (clopidogrel and aspirin) to prevent thrombotic processes, as a preventative measure in patients with acute coronary disease, or in patients subjected to percutaneous coronary intervention. Objective: The purpose of this study was to evaluate the efficacy of a protocol for performing dental extraction in patients receiving dual antiplatelet therapy. Material and Methods: Thirty-two patients undergoing dental extractions were included in the study. The variables evaluated were: collagen-epinephrine fraction, collagen- adenosine diphosphate fraction, surgical surface, post-surgical measures, and adverse effects. Alveolar sutures and gauzes impregnated with an antifibrinolytic agent (tranexamic acid), which the patient pressed in place for 30 minutes, were applied to all patients as post- surgical measures. Descriptive statistics were calculated and analyzed with Student’s t-test to compare pairs of quantitative variables; simple regression analysis was performed using Pearson’s correlation coefficient. Statistical significance was set at p <0.05. Results: Collagen/epinephrine fraction was 264.53±55.624 seconds with a range of 135 to 300 seconds, and collagen/ADP fraction was 119.41±44.216 seconds, both values being higher than normal. As a result of the postsurgical measures taken, no patients presented post-operative bleeding, hematoma or infection. Conclusions: Dental extraction was safe for patients receiving dual anti-platelet therapy when using sutures and gauze impregnated with tranexamic acid, which the patient pressed in place for 30 minutes

Development of a diagnostic algorithm in periodontal disease and identification of genetic expression patterns: A preliminary report

AbstractBackground/purposeTo identify genetic expression patterns that can be used to define an appropriate diagnostic algorithm of clinical use in periodontal disease.Materials and methodsTotal RNA was extracted from 13 samples corresponding to normal human gingiva (NHG) and human gingiva affected by periodontal disease (PDHG). A comprehensive gene expression analysis was carried out by microarray analysis using Affymetrix Human Genome U133 plus 2.0 oligonucleotide arrays.ResultsSixty-six probe sets (genes and expressed sequence tags – EST) overexpressed in all samples of one of the comparison groups, were used for the diagnostic algorithm. All samples, including an independent test sample, were correctly classified as normal or periodontally affected using the diagnostic algorithm. In addition, 2596 genes/EST were upregulated and 1542 genes/EST were downregulated in PDHG, with numerous gene functions impaired in PDHG, especially those related to the immune response, cell-cell junctions, and extracellular matrix remodeling.ConclusionOur study reveals differential gene expression profiles in NHG and PDHG. The proposed diagnostic algorithm could have clinical usefulness for differential diagnosis in periodontal disease

Histological and histochemical evaluation of human oral mucosa constructs developed by tissue engineering

Reconstruction of large oral mucosa defects is often challenging, since the shortage of healthy oral mucosa to replace the excised tissues is very common. In this context, tissue engineering techniques may provide a source of autologous tissues available for transplant in these patients. In this work, we developed a new model of artificial oral mucosa generated by tissue engineering using a fibrin-agarose scaffold. For that purpose, we generated primary cultures of human oral mucosa fibroblasts and keratinocytes from small biopsies of normal oral mucosa using enzymatic treatments. Then we determined the viability of the cultured cells by electron probe quantitative X-ray microanalysis, and we demonstrated that most of the cells in the primary cultures were alive and had high K/Na ratios. Once cell viability was determined, we used the cultured fibroblasts and keratinocytes to develop an artificial oral mucosa construct by using a fibrin-agarose extracellular matrix and a sequential culture technique using porous culture inserts. Histological analysis of the artificial tissues showed high similarities with normal oral mucosa controls. The epithelium of the oral substitutes had several layers, with desmosomes and apical microvilli and microplicae. Both the controls and the oral mucosa substitutes showed high suprabasal expression of cytokeratin 13 and low expression of cytokeratin 10. All these results suggest that our model of oral mucosa using fibrin-agarose scaffolds show several similarities with native human oral mucosa.This work was supported by the grants FIS 03/0141 and FIS 04/1306 from the Spanish National Ministry of Health (Instituto de Salud Carlos III) and by CM 2005/011 from Junta de Andalucía

Microscopia electrónica de barrido del epitelio periodontal de protección

Reducción altaUniv. de Granada, 199

Manifestaciones gingivales en niños españoles con maloclusión.

In this study we analize gingival overgrowth and recession prevalence in class I maloccclusion syndrome and its relation with openbites, crossbites, dental crowding and mouthbreathing. A sample of 254 Spanish class I malocclusive individuals (140 females and 114 males) of 9.1 + 1.6 years old was analized. Results show high overgrowth and recession prevalence, without sexual dymorphism. The biggest relation with gingival overgrowth or recession was observed for dental crowding. Ulterior studies must define specific factors in relation with our results.En el presente trabajo analizamos la prevalencia de agrandamientos y recesiones gingivales en el síndrome maloclusivo de clase I así como su relación con la presencia de mordidas abiertas, mordidas cruzadas posteriores, apiñamientos oseodentarios y respiración oral. Para ello analizamos una muestra de 254 niños españoles maloclusivos de clase I ósea y/o dentaria (140 niñas y 114 niños) de 9.1 + 1.6 años de edad. Nuestros resultados muestran una alta prevalencia en la población estudiada tanto de agrandamientos como de recesiones gingivales, sin dimorfismo sexual. De entre los factores analizados, el apiñamiento oseodentario es el que más condiciona la presencia de agrandamiento o recesión gingival. UIteriores estudios habrán de matizar qué factores específicos condicionan los hallazgos obtenidos en este estudio

Stability and marginal bone loss in implants placed using piezoelectric osteotomy versus conventional drilling: systematic review and meta-analysis

Background: The main objective of this systematic review was to compare primary and secondary implant stability between placement with piezoelectric osteotomy and conventional drilling, comparing marginal bone losses as a secondary objective. Material and Methods: An electronic search was conducted using PubMed (MEDLINE), Scopus, and Cochrane Library (Wiley) databases, besides a manual search. Results: A total of 153 articles were retrieved, 39 from Pubmed, 44 from Scopus, and 70 from the Cochrane Library. After removing duplicates, 112 articles (1 from the manual search) were screened, and 9 were finally selected for qualitative and statistical analyses. Conclusions: Piezoelectric surgery is a predictable alternative to conventional drilling for dental implant placement. Medium/long-term survival rates and marginal bone losses are similar between piezoelectric osteotomy and conventional drilling, and there is no difference in ISQ values for primary stability. However, implants placed with ultrasound showed a lower decrease in implant stability quotient (ISQ) during the osseointegration period and a higher ISQ value for secondary stability. This study contributes further information on peri-implant bone tissue at 3 and 6 months after implant placement with piezoelectric osteotomy or conventional drilling and provides an updated meta-analysis of comparative studies