RESUMEN
A case report illustrating the successful treatment of a gingival fenestration with an acellular dermal matrix (ADM) allograft. After 2½ months of healing, the ADM was completely integrated into the soft tissues of the mandibular anterior gingiva with complete resolution of the gingival fenestration, resulting in excellent gingival esthetics.
Asunto(s)
Dermis Acelular , Enfermedades de las Encías/cirugía , Adulto , Aloinjertos , Enfermedades de las Encías/patología , Recesión Gingival/patología , Recesión Gingival/cirugía , Humanos , Masculino , Personal Militar , Resultado del TratamientoRESUMEN
BACKGROUND: Application of recombinant human bone morphogenetic protein-2 (rhBMP-2) has been associated with significant adverse events in craniofacial settings, including swelling and seroma formation. Recent work has demonstrated an inverse relationship between bone formation/maturation and rhBMP-2 dose, frequency/severity of adverse events increasing with rising dose. OBJECTIVE: The objective of this study was to determine the most effective dose for rhBMP-2 soak-loaded onto an absorbable collagen sponge (ACS) carrier for bone formation/maturation using an established defect model. METHODS: One hundred sixty-eight outbred male Sprague-Dawley rats, age 11-13 weeks, weight 325-375 g randomized into seven groups of 24 subdivided into groups of eight, were used to provide radiographic and light microscopy observations of bone formation/maturation and aberrant healing events at 2, 4 and 8 weeks following application of rhBMP-2/ACS into critical-size, ø8-mm, through-through, calvarial osteotomy defects for a dose of 1.25, 2.5, 5.0, 10.0 and 20.0 µg rhBMP-2/defect, or serve as ACS or sham-surgery controls. RESULTS: rhBMP-2 dosages ≥ 2.5 µg/defect showed histological defect closure >90% within 2 weeks, and complete resolution within 4 weeks. Adverse healing events including swelling, excessive bone formation or seroma formation could not be determined with certainty in this defect model. Notably ACS control sites showed complete defect closure at the 8-week healing interval. CONCLUSIONS: rhBMP-2/ACS accelerates local bone formation in the rat critical-size through-through calvarial defect model once reaching an osteoinductive dose threshold. This threshold may already be reached at a 1.25-/2.5-µg dose in this model. No further enhancement to bone formation/maturation may be observed adding rhBMP-2 above the 2.5-µg dose. The 1.25-20.0 µg dose range did not invoke appreciable aberrant healing events.
Asunto(s)
Enfermedades Óseas/tratamiento farmacológico , Proteína Morfogenética Ósea 2/uso terapéutico , Osteogénesis/efectos de los fármacos , Hueso Parietal/efectos de los fármacos , Factor de Crecimiento Transformador beta/uso terapéutico , Implantes Absorbibles , Animales , Densidad Ósea/efectos de los fármacos , Médula Ósea/efectos de los fármacos , Médula Ósea/patología , Proteína Morfogenética Ósea 2/administración & dosificación , Calcificación Fisiológica/efectos de los fármacos , Colágeno , Relación Dosis-Respuesta a Droga , Portadores de Fármacos , Masculino , Hueso Parietal/patología , Distribución Aleatoria , Ratas , Ratas Sprague-Dawley , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/uso terapéutico , Factores de Tiempo , Factor de Crecimiento Transformador beta/administración & dosificación , Cicatrización de Heridas/efectos de los fármacosRESUMEN
PURPOSE: To investigate the effects of hyperglycemia and metformin (a popular biguanide antidiabetic) on periimplant healing. METHODS: Thirty-six male rats were assigned to 3 groups: (1) nondiabetic Wistar-Kyoto rats (controls), (2) Goto-Kakizaki (GK) spontaneously diabetic rats (GK group), and (3) GK rats were fed metformin (100 mg/kg body weight per day) in their water for 4 weeks (GK + Met group). The right maxillary first molars were extracted and sites were allowed 1 month to heal. Titanium implants (1 × 3 mm) were placed in healed extraction sites. Six rats from each group were analyzed at weeks 1 and 4 by micro computed tomography for bone/implant contact ratio, percent bone volume, trabecular number, and bone mineral density. Blood was also analyzed for glucose, HbA1c, and pyridinoline (PYD). RESULTS: At week 1, glucose levels in the GK-Met rats were high, and all bone parameters were similar to GK rats (lower bone parameters and higher PYD than controls). At week 4, glucose levels in the GK-Met rats and all parameters were similar to controls. CONCLUSIONS: Hyperglycemic GK type 2 diabetic rats showed improved blood glucose and wound healing around oral implants after metformin administration.
Asunto(s)
Implantes Dentales/efectos adversos , Diabetes Mellitus Tipo 2/complicaciones , Hipoglucemiantes/uso terapéutico , Metformina/uso terapéutico , Extracción Dental/efectos adversos , Cicatrización de Heridas/efectos de los fármacos , Animales , Glucemia/análisis , Glucemia/efectos de los fármacos , Remodelación Ósea/efectos de los fármacos , Remodelación Ósea/fisiología , Modelos Animales de Enfermedad , Masculino , Ratas , Ratas Endogámicas , Ratas Endogámicas WKY , Microtomografía por Rayos XRESUMEN
The submandibular salivary glands of non-obese diabetic (NOD) mice, a model for Sjogren's syndrome and type-1 diabetes, show an elevated level of proliferating cell nuclear antigen (PCNA), a protein involved in cell proliferation and repair of DNA damage. We reported previously that epigallocatechin-3-gallate (EGCG), the most abundant green tea catechin, normalizes the PCNA level. PCNA's activity can be regulated by the cyclin-dependent kinase inhibitor p21, which is also important for epithelial cell differentiation. In turn, expression of p21 and PCNA are partially regulated by Rb phosphorylation levels. EGCG was found to modulate p21 expression in epithelial cells, suggesting that EGCG-induced p21 could be associated with down-regulation of PCNA in vivo. The current study examined the protein levels of p21 and p53 (which can up-regulate p21) in NOD mice fed with either water or EGCG, and the effect of EGCG on p21 and p53 in cell line models with either normal or defective Rb. In NOD mice, the p21 level was low, and EGCG normalized it. In contrast to HSG cells with functional Rb, negligible expression of p21 in NS-SVAC cells that lack Rb was not altered by EGCG treatment. Inhibition of p53 by siRNA demonstrated that p21 and p53 were induced independently in HSG cells by a physiological concentration range of EGCG, suggesting p53 could be an important but not conditional factor associated with p21 expression. In conclusion, PCNA and p21 levels are altered inversely in the NOD model for SS and in HSG cells, and warrant further study as candidate new markers for salivary dysfunction associated with xerostomia. Induction of p21 by EGCG could provide clinically useful normalization of salivary glands by promoting differentiation and reducing PCNA levels.
Asunto(s)
Anticarcinógenos/administración & dosificación , Catequina/análogos & derivados , Inhibidor p21 de las Quinasas Dependientes de la Ciclina/metabolismo , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Células Epiteliales/metabolismo , Antígeno Nuclear de Célula en Proliferación/metabolismo , Glándulas Salivales/metabolismo , Síndrome de Sjögren/tratamiento farmacológico , Proteína p53 Supresora de Tumor/metabolismo , Xerostomía/tratamiento farmacológico , Animales , Anticarcinógenos/efectos adversos , Catequina/administración & dosificación , Catequina/efectos adversos , Línea Celular Tumoral , Modelos Animales de Enfermedad , Regulación hacia Abajo , Células Epiteliales/efectos de los fármacos , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos NOD , Proteína de Retinoblastoma/metabolismoRESUMEN
Pyogenic granuloma is a benign nodular lesion occurring most commonly on the gingiva of females during periods of elevated sex hormones such as puberty and pregnancy. Possible molecular mechanisms responsible for the appearance of pyogenic granuloma in this demographic have been suggested. Increased incidence of pyogenic granuloma in post menopausal women on hormone replacement therapy has not been reported. A 49-year-old woman with preexisting titanium implant placement in the left posterior mandible presented with complaint of food impaction and slight discomfort associated with the implant. Clinical examination revealed slight soft tissue erythema and edema, but no foreign body could be identified. Subsequently, a nodular gingival lesion associated with the implant developed and was treated by conservative surgical excision. Histologic characteristics of the lesion were consistent with pyogenic granuloma. The patient was informed of the diagnosis. No evidence of recurrence could be identified after 6 months. Like peripubertal and pregnant women, postmenopausal women treated with hormone replacement therapy may be at increased risk for pyogenic granuloma. Observational studies designed to establish an association between hormone replacement therapy and pyogenic granuloma have not been conducted. Dentists should be aware of putative pathophysiologic mechanisms for pyogenic granuloma formation and the possibility that hormone replacement may trigger these mechanisms.
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Implantes Dentales/efectos adversos , Terapia de Reemplazo de Estrógeno/efectos adversos , Enfermedades de las Encías/etiología , Granuloma Piogénico/etiología , Osteoporosis Posmenopáusica/prevención & control , Diagnóstico Diferencial , Estrógenos Conjugados (USP)/efectos adversos , Femenino , Enfermedades de las Encías/patología , Granuloma Piogénico/patología , Humanos , Mandíbula , Persona de Mediana EdadRESUMEN
Conventional surgical procedures designed for autogenous tissue material may not be appropriate when using acellular dermal matrix (ADM) for the treatment of gingival recessions. This article describes a new surgical technique that addresses the unique and sensitive aspects of ADM specifically to improve esthetic outcomes and gain increased clinical predictability when treating Miller Class I and II gingival recession defects. In this paper, a root coverage case is described and the specific steps and rationale for this new technique are explained. This technique has been predictable clinically, with results comparable to those achieved using autogenous tissue.
Asunto(s)
Colágeno , Recesión Gingival/cirugía , Gingivoplastia/métodos , Piel Artificial , Adulto , Femenino , Gingivoplastia/instrumentación , Humanos , Colgajos QuirúrgicosRESUMEN
AIM: The objective of this study was to evaluate the effect of a novel recombinant human GDF-5 (rhGDF-5) construct intended for onlay and inlay indications on periodontal wound healing/regeneration. METHODS: Contralateral, surgically created, critical-size, 6-mm, supra-alveolar periodontal defects in five adult Hound Labrador mongrel dogs received rhGDF-5 coated onto beta-tricalcium phosphate (beta-TCP) particles and immersed in a bioresorbable poly(lactic-co-glycolic acid) (PLGA) composite or the beta-TCP/PLGA carrier alone (control). The rhGDF-5 and control constructs were moulded around the teeth and allowed to set. The gingival flaps were then advanced; flap margins were adapted 3-4 mm coronal to the teeth and sutured. The animals were euthanized at 8 weeks post-surgery when block biopsies were collected for histometric analysis. RESULTS: Healing was generally uneventful. A few sites exhibited minor exposures. Three control sites and one rhGDF-5 site (in separate animals) experienced more extensive wound dehiscencies. The rhGDF-5 and control constructs were easy to apply and exhibited adequate structural integrity to support the mucoperiosteal flaps in this challenging onlay model. Limited residual beta-TCP particles were observed at 8 weeks for both rhGDF-5/beta-TCP/PLGA and beta-TCP/PLGA control sites. The rhGDF-5/beta-TCP/PLGA sites showed significantly greater cementum (2.34 +/- 0.44 versus 1.13 +/- 0.25 mm, p=0.02) and bone (2.92 +/- 0.66 versus 1.21 +/- 0.30 mm, p=0.02) formation compared with the carrier control. Limited ankylosis was observed in four of five rhGDF-5/beta-TCP/PLGA sites but not in control sites. CONCLUSIONS: Within the limitations of this study, the results suggest that rhGDF-5 is a promising candidate technology in support of periodontal wound healing/regeneration. Carrier and rhGDF-5 dose optimization are necessary before further advancement of the technology towards clinical evaluation.
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Implantes Absorbibles , Cementogénesis/efectos de los fármacos , Portadores de Fármacos , Factor 5 de Diferenciación de Crecimiento/administración & dosificación , Periodoncio/cirugía , Regeneración/efectos de los fármacos , Animales , Regeneración Ósea/efectos de los fármacos , Fosfatos de Calcio , Perros , Humanos , Masculino , Ligamento Periodontal/fisiología , Poliésteres , Proteínas Recombinantes , Cicatrización de Heridas/efectos de los fármacosRESUMEN
OBJECTIVE: The objective of this study was to evaluate local bone formation following systemic administration of parathyroid hormone (1-34) (PTH), a surgically implanted synthetic beta-tricalcium phosphate (beta-TCP) bone biomaterial serving as a matrix to support new bone formation. MATERIALS AND METHODS: Critical-size, 8 mm, calvarial through-and-through osteotomy defects were surgically created in 100 adult male Sprague-Dawley rats. The animals were randomized into five groups of 20 animals each to receive one of the following treatments: PTH (15 microg PTH/kg/day; subcutaneously), PTH/beta-TCP, beta-TCP, or particulate human demineralized freeze-dried bone (DFDB), and sham-surgery controls. Ten animals/group were euthanized at 4 and 8 weeks post-surgery for radiographic and histometric analysis. RESULTS: The histometric analysis showed that systemic PTH significantly enhanced local bone formation, bone fill averaging (+/-SE) 32.2+/-4.0% compared with PTH/beta-TCP (15.7+/-2.4%), beta-TCP (12.5+/-2.3%), DFDB (14.5+/-2.3%), and sham-surgery control (10.0+/-1.5%) at 4 weeks (p<0.014). Systemic PTH showed significantly enhanced bone formation (41.5+/-4.0%) compared with PTH/beta-TCP (22.4+/-3.0%), beta-TCP (21.3+/-4.4%), and with the sham-surgery control (23.8+/-4.2%) at 8 weeks (p<0.025). The DFDB group showed significantly increased bone formation from 4 (14.5+/-2.3%) to 8 weeks (32.0+/-3.2%) (p<0.006). The PTH/beta-TCP and beta-TCP groups both showed limited biomaterials resorption. The radiographic analysis was not diagnostic to distinguish local bone formation from the radiopaque beta-TCP biomaterial. CONCLUSIONS: Systemic administration of PTH significantly stimulates local bone formation. Bone formation was significantly limited by the beta-TCP biomaterial.
Asunto(s)
Conservadores de la Densidad Ósea/farmacología , Regeneración Ósea/efectos de los fármacos , Hormona Paratiroidea/farmacología , Animales , Conservadores de la Densidad Ósea/administración & dosificación , Matriz Ósea/trasplante , Fosfatos de Calcio/farmacología , Inyecciones , Masculino , Hormona Paratiroidea/administración & dosificación , Distribución Aleatoria , Ratas , Ratas Sprague-Dawley , Cráneo/cirugíaRESUMEN
SIGNIFICANCE: Protection of glandular cells from autoimmune-induced damage would be of significant clinical benefit to Sjogren's syndrome (SS) patients. Epigallocatechin-3-gallate (EGCG) possesses anti-apoptotic, anti-inflammatory, and autoantigen-inhibitory properties. AIMS: To investigate if EGCG protects against certain autoimmune-induced pathological changes in the salivary glands of the non-obese diabetic (NOD) mouse model for SS. MAIN METHODS: Animals were provided with either water or water containing 0.2% EGCG. At the age of 8, 16 and 22 weeks, submandibular salivary gland tissue and serum samples were collected for pathological and serological analysis. KEY FINDINGS: Significant lymphocyte infiltration was observed in the salivary glands of the water-fed group at the age of 16 weeks, while the EGCG group showed reduced lymphocyte infiltration. By 22 weeks of age, water-fed animals demonstrated elevated levels of apoptotic activity within the lymphocytic infiltrates, and high levels of serum total anti-nuclear antibody, compared to EGCG-fed animals. Remarkably, proliferating cell nuclear antigen (PCNA) and Ki-67 levels in the salivary glands of water-fed NOD mice were significantly elevated in comparison to BALB/c control mice; in contrast, PCNA and Ki-67 levels in EGCG-fed NOD animals were similar to BALB/c mice. These results indicate that EGCG protects the NOD mouse submandibular glands from autoimmune-induced inflammation, and reduces serum autoantibody levels. Abnormal proliferation, rather than apoptosis, appears to be a characteristic of the NOD mouse gland that is normalized by EGCG. The evidence suggests that EGCG could be useful in delaying or managing SS-like autoimmune disorders.
Asunto(s)
Catequina/análogos & derivados , Síndrome de Sjögren/tratamiento farmacológico , Té/química , Administración Oral , Animales , Anticuerpos Antinucleares/sangre , Apoptosis/efectos de los fármacos , Catequina/uso terapéutico , Diabetes Mellitus Tipo 1/prevención & control , Modelos Animales de Enfermedad , Femenino , Humanos , Antígeno Ki-67/análisis , Linfocitos/fisiología , Ratones , Ratones Endogámicos NOD , Fitoterapia , Antígeno Nuclear de Célula en Proliferación/análisis , Glándula Submandibular/efectos de los fármacos , Glándula Submandibular/patologíaRESUMEN
BACKGROUND: Cigarette smoking can adversely affect the results of many periodontal procedures. The purpose of this study was to determine whether cigarette smoking affects wound healing of subepithelial connective tissue grafts. METHODS: Seventeen systemically healthy patients with 22 Miller Class I or II mucogingival defects were divided into a non-smoker group or smoker group. Patients were regarded as smokers if they reported smoking 10 to 20 cigarettes per day. The following parameters were documented at the surgery date and 3 and 6 months postoperatively: recession depth (RD), recession width (RW), keratinized gingiva height measured apico-coronally (KG), relative attachment level (RAL), probing depths (PD), bleeding on probing (BOP), and the full-mouth plaque score (FMP). Salivary cotinine samples were taken at the surgery to confirm the smoking history and to quantify cigarette use. RESULTS: Non-smokers (0- to 10-ng/ml cotinine level) healed with statistically more recession coverage than the smokers (>10-ng/ml cotinine level) (98.3% versus 82.3%, respectively; P=0.001). Six months postoperatively, the non-smokers healed with a 0.2-mm mean recession depth compared to a 1.0-mm mean recession depth for the smokers. This difference in recession depth was statistically significant (P=0.014). CONCLUSIONS: Root coverage with connective tissue grafts appears to be negatively associated with cigarette smoking. Smokers should consider smoking cessation or reducing the use of cigarettes for optimal results with connective tissue grafts.