RESUMEN
As the most potent cells activating and polarizing naive T cells, dendritic cells (DCs) are of major importance in the induction of immunity and tolerance. DCs are a heterogeneous population of antigen-presenting cells that are widely distributed in lymphoid and nonlymphoid tissues. Murine studies have highlighted the important role of oral DCs and Langerhans cells (LCs) in orchestrating the physiological homeostasis of the oral mucosa. DCs are also critically involved in pathological conditions such as periodontal diseases, in which gingival DCs appear to have special localization and function. While the characterization of human DCs in health and disease has been extensively investigated in various tissues, this topic was rarely studied in human gingiva. Here, we employed an up-to-date approach to characterize by flow cytometry the gingival DCs of 27 healthy subjects and 21 periodontal patients. Four distinct subsets of mononuclear phagocytes were identified in healthy gingiva: conventional DC type 1 (cDC1), cDC2, plasmacytoid DCs (pDCs), and LCs. In periodontitis patients, the frequencies of gingival LCs and pDCs were dysregulated, as LCs decreased, whereas pDCs increased in the diseased gingiva. This shift in the prevalence of DCs was accompanied by increased expression of the proinflammatory cytokines interleukin (IL)-1ß, interferon (IFN)-α, and IFN-γ, while the anti-inflammatory cytokine IL-10 was suppressed. We further found that smoking, a known risk factor of periodontitis, specifically reduces gingival LCs in healthy individuals, indicating a possible role of LCs in the elevated severity of periodontitis in smokers. Collectively, this work reveals the various DC subsets residing in the human gingiva and the impact of periodontitis, as well as smoking, on the prevalence of each subset. Our findings provide a foundation toward understanding the role of human DCs in orchestrating physiological oral immunity and set the stage for the evaluation and modulation of shifts in immunity associated with periodontitis.
Asunto(s)
Encía , Periodontitis , Animales , Células Dendríticas , Humanos , Ratones , Periodontitis/epidemiología , Prevalencia , Linfocitos TRESUMEN
The debate regarding prophylactic extraction of mandibular third molar (Wisdom teeth) is not new. There is wide agreement among clinicians and researchers that an extraction in young age is easier and safer, but it may result in overtreatment, which means an unnecessary extraction of teeth that might have been functional and healthy. In order to avoid such overtreatment the clinician is obliged to be able to predict accurately the chances of third molar eruption, years before they are due to erupt. Additionally, the clinician has to estimate the chances for future pathology or infection that will force the patient to extract the tooth in years to come. In order to do so the clinician has to meticulously examine the teeth both clinically (including caries assessment of neighboring teeth, periodontal pocket depth measurements etc.) and radiographically. The purpose of this literature review is to present a balanced approach towards the issue of early prophylactic extraction of mandibular third molar.
Asunto(s)
Tercer Molar/cirugía , Erupción Dental , Extracción Dental/métodos , Factores de Edad , Humanos , Factores de TiempoRESUMEN
Virtual surgical planning (VSP) is a tool for predicting complex surgical movements in three dimensions and it may reduce preoperative laboratory time. A prospective study to compare the time required for standard preoperative planning versus VSP was conducted at Massachusetts General Hospital from January 2014 through January 2015. Workflow data for bimaxillary cases planned by both standard techniques and VSP were recorded in real time. Time spent was divided into three parts: (1) obtaining impressions, face-bow mounting, and model preparation; (2) occlusal analysis and modification, model surgery, and splint fabrication; (3) online VSP session. Average times were compared between standard treatment planning (sum of parts 1 and 2) and VSP (sum of parts 1 and 3). Of 41 bimaxillary cases included, 20 were simple (symmetric) and 21 were complex (asymmetry and segmental osteotomies). Average times for parts 1, 2, and 3 were 4.43, 3.01, and 0.67h, respectively. The average time required for standard treatment planning was 7.45h and for VSP was 5.10h, a 31% time reduction (P<0.001). By eliminating all or some components of part 1, time savings may increase to as much as 91%. This study indicates that in an academic setting, VSP reduces the time required for treatment planning of bimaxillary orthognathic surgery cases.
Asunto(s)
Tempo Operativo , Procedimientos Quirúrgicos Ortognáticos , Planificación de Atención al Paciente/estadística & datos numéricos , Cirugía Asistida por Computador/estadística & datos numéricos , Humanos , Estudios ProspectivosRESUMEN
Obstructive sleep apnea may be a life threatening situation if does not get proper attention. Risk factors are easy to find, therefore general dental surgeons should be aware of them and refer if needed. This literature review clearly explains how obstructive sleep apnea is diagnosed and treated. We present a case of a patient with severe obstructive sleep apnea (apnea hypopnea index of 87.5/hour), who underwent bi jaw surgery with 2 piece Le Fort 1 maxiilary advancement, mandibular bilateral sagittal split osteotomy (BSSO) advancement, and genial tubercle advancement. Post-surgery sleep study demonstrated near resolution of previously severe obstructive sleep apnea with overall apnea hypopnea index (AHI) of 3.7/hour consistent with a successful surgical outcome.
Asunto(s)
Mandíbula/cirugía , Osteotomía/métodos , Apnea Obstructiva del Sueño/cirugía , Adulto , Humanos , Masculino , Factores de Riesgo , Índice de Severidad de la Enfermedad , Apnea Obstructiva del Sueño/diagnóstico , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate serum levels of interleukin (IL)-1, IL-6, IL-8, IL-10, soluble IL-2 receptor (sIL-2R), squamous cell carcinoma antigen (SCCA), tissue polypeptide-specific antigen (TPS) and vascular endothelial growth factor (VEGF) in patients with potentially malignant disorders (PMD), oral squamous cell carcinoma (OSCC), or status-post (SP) OSCC. SUBJECTS AND METHODS: Blood was collected from 47 patients, either controls or diagnosed with PMD, OSCC, or SPOSCC. Levels of cytokines and tumor marker were evaluated by ELISAs. Normal levels were based on previous studies and pathology determined by chi-square and Fisher's exact tests. P ≤ 0.05 was considered statistically significant. RESULTS: Above normal levels of SCCA were found for OSCC and dysplasia patients (33.3% and 11.1%, respectively) and high range of normal (upper 20% of the normal range) for lichen planus, SPOSCC, and dysplasia patients (6.67%, 33.3%, and 22.2%, respectively), differences that approached statistical significance (P = 0.055). No differences were found between groups for other tested markers. A progression was seen for SCCA from high range of normal in SPOSCC to a mixture of high normal and elevated in dysplasia to elevated in active OSCC, suggesting that SCCA may be correlated with cancer progression. CONCLUSION: Higher levels of serum SCCA may serve as a marker for dysplasia and progression to oral carcinogenesis.
Asunto(s)
Antígenos de Neoplasias/sangre , Biomarcadores de Tumor/sangre , Carcinoma de Células Escamosas/sangre , Citocinas/sangre , Neoplasias de la Boca/sangre , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Interleucinas/sangre , Masculino , Persona de Mediana Edad , Proyectos Piloto , Factor A de Crecimiento Endotelial Vascular/sangreRESUMEN
Vertical augmentation for rehabilitation with dental implants poses a clinical challenge. The surgical obstacles have been extensively documented within the literature. Outcomes of the multiple methods available are not predictable, and overall success rates are sub-optimal. This paper presents the Sandwich Osteotomy Technique (interpositional rhBMP-2 and bone subtitute grafting) in a young female with congenital oligodontia. The uniqueness of this method, like in distraction osteogenesis, is that the segmental bone remains attached to the mucoperiosteal flap and thus the blood supply is maintained. Bone graft or substitute is introduced into the interpositional space that was created. Advantages of Sandwich Osteotomy are minimal bone exposure, good blood supply, no need for donor bone graft and minimal overall morbidity. Limitations of the technique are soft tissue stretching, gingival fibrosis, and high technical demand. According to our experience with this surgical method, vertical augmentation is stable up to 8 mm. Beyond this height approximately 10% bone resorption was noticed.
Asunto(s)
Aumento de la Cresta Alveolar/métodos , Anodoncia/cirugía , Implantación Dental Endoósea/métodos , Osteotomía/métodos , Implantes Dentales , Femenino , Humanos , Adulto JovenRESUMEN
OBJECTIVES: The purpose of the study was to characterize local and systemic clinical parameters of odontogenic infections in adults, and to isolate parameters that can predict hospital length of stay (LOS). METHODS: File charts of 142 patients, hospitalized between 1994 and 2004 in the Department of Oral and Maxillofacial Surgery of the Sheba Medical Center, were reviewed. Pre-hospitalization data (age, gender, clinical characteristics of the infection, antibiotic intake), and data during hospitalization (blood count, body temperature, heart rate, blood pressure, thrombocytes count, anatomic space involved, cause of infection, type of infection abscess or cellulitis, surgical treatment applied and length of stay) were collected and statistically analyzed to isolate which mostly correlated to LOS--long (4 or more days) or short (less than 4 days). Stepwise logistic regression model was carried out to obtain a predictive model for short or long LOS using the statistically significant parameters. RESULTS: Systemic clinical findings, such as body temperature, blood pressure, heart rate, and WBC count, had normal to slightly elevated values. High blood count PMN, surgical intervention, infraorbital space involvement, and infection in the mandible were significant to LOS. The most important parameter, masking all other significant parameters, was the location of infection. When the maxilla was compared to the mandible, the odds for a long LOS were 3.2 times greater in the mandible. CONCLUSIONS: Orofacial odontogenic infections may be regarded as local infection rather than systemic disease. Hospital LOS is influenced directly by infection location, i.e., lower face (mandible) infection requires a longer LOS.