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Limirio PHJO, De Oliveira Neto NF, Venâncio JF, Linhares CRB, Soares PBF, Dechichi P. Insulin Therapy on Bone Macroscopic, Microarchitecture, and MechanicalProperties of Tibia in Diabetic Rats. Curr Diabetes Rev 2024; 20:e030124225214. [PMID: 38178671 DOI: 10.2174/0115733998270859231117091741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND This study evaluated tibia's macroscopic structure, mechanical properties, and bone microarchitecture in rats with type 1 diabetes mellitus (T1DM). METHODS Eighteen animals were divided into three groups (n=6): Non-diabetic (ND), diabetic (D), and diabetic+insulin (DI). T1DM was induced by streptozotocin; insulin was administered daily (4IU). The animals were euthanized 35 days after induction. The tibiae were removed and analyzed using macroscopic, micro-computed tomography (micro-CT) and three-point bending. The macroscopic analysis measured proximal-distal length (PD), antero-posterior thickness (AP) of proximal (AP-P) and distal (AP-D) epiphysis, and lateral-medial thickness (LM) of proximal (LM-P) and distal (LM-D) epiphysis. Micro-CT analysis closed porosity, tissue mineral density, and cortical thickness. The three-point bending test measured maximum strength, energy, and stiffness. RESULTS The macroscopic analysis showed that D presented smaller measures of length and thickness (AP and AP-P) than ND and DI. More extensive measurements were observed of LM and AP-D thickness in DI than in D. In micro-CT, DI showed larger cortical thickness than D. Mechanical analysis showed lower strength in D than in other groups. CONCLUSIONS T1DM reduces bone growth and mechanical strength. Insulin therapy in diabetic rats improved bone growth and fracture resistance, making diabetic bone similar to normoglycemic animals.
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Affiliation(s)
- Pedro Henrique Justino Oliveira Limirio
- Departamento de Periodontia e Implantodontia, Integrated Dental Clinic Program, School of Dentistry, University of Uberlândia, Avenida Pará s/nº, Campus Umuarama, Bloco 4L, Uberlândia, Minas Gerais,38.400-902, Brazil
| | - Nilson Ferreira De Oliveira Neto
- Departamento de histologia, Integrated Dental Clinic Program, School of Dentistry, University of Uberlândia, Avenida Pará 1720, Campus Umuarama, Bloco 2B, Bairro Umuarama. Uberlândia, Minas Gerais, 38.400-902, Brazil
| | - Jessyca Figueira Venâncio
- Departamento de histologia, Integrated Dental Clinic Program, School of Dentistry, University of Uberlândia, Avenida Pará 1720, Campus Umuarama, Bloco 2B, Bairro Umuarama. Uberlândia, Minas Gerais, 38.400-902, Brazil
| | - Camila Rodrigues Borges Linhares
- Departamento de histologia, Integrated Dental Clinic Program, School of Dentistry, University of Uberlândia, Avenida Pará 1720, Campus Umuarama, Bloco 2B, Bairro Umuarama. Uberlândia, Minas Gerais, 38.400-902, Brazil
| | - Priscilla Barbosa Ferreira Soares
- Department of Periodontology and Implantology, University of Uberlândia. Avenida Pará 1720, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38.400-902, Brazil
| | - Paula Dechichi
- Departamento de histologia, Biomedical Science Institute, University of Uberlândia, Avenida Pará 1720, Campus Umuarama, Bloco 2B, Bairro Umuarama,Uberlândia, Minas Gerais, 38.400-902, Brazil
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Linhares CRB, Rabelo GD, Limirio PHJO, Venâncio JF, Ribeiro Silva IG, Dechichi P. Automated bone healing evaluation: New approach to histomorphometric analysis. Microsc Res Tech 2022; 85:3339-3346. [PMID: 35758056 DOI: 10.1002/jemt.24188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/16/2022] [Accepted: 06/10/2022] [Indexed: 12/23/2022]
Abstract
This study aimed to assess different approaches for bone healing evaluation on histological images and to introduce a new automatic evaluation method based on segmentation with distinct thresholds. We evaluated the hyperbaric oxygen therapy (HBO) effects on bone repair in type 1 diabetes mellitus rats. Twelve animals were divided into four groups (n = 3): non-diabetic, non-diabetic + HBO, diabetic, and diabetic + HBO. Diabetes was induced by intravenous administration of streptozotocin (50 mg/kg). Bone defects were created in femurs and HBO was immediately started at one session/day. After 7 days, the animals were euthanized, femurs were removed, demineralized, and embedded in paraffin. Histological sections were stained with hematoxylin and eosin (HE) and Mallory's trichrome (MT), and evaluated using three approaches: (1) conventional histomorphometric analysis (HE images) using a 144-point grid to quantify the bone matrix; (2) a semi-automatic method based on bone matrix segmentation to assess the bone matrix percentage (MT images); and (3) automatic approach, with the creation of a plug-in for ImageJ software. The time required to perform the analysis in each method was measured and subjected to Bland-Altman statistical analysis. All three methods were satisfactory for measuring bone formation and were not statistically different. The automatic approach reduced the working time compared to visual grid and semi-automated method (p < .01). Although histological evaluation of bone healing was performed successfully using all three methods, the novel automatic approach significantly shortened the time required for analysis and had high accuracy.
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Affiliation(s)
| | - Gustavo Davi Rabelo
- Dentistry Department, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | | | | | - Paula Dechichi
- Department of Cell Biology, Histology and Embryology, Biomedical Science Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
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Systemic Literature Review on Multilevel Analysis of Radiation Effects on Bone Microarchitecture. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9890633. [PMID: 35782085 PMCID: PMC9249517 DOI: 10.1155/2022/9890633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 04/14/2022] [Accepted: 04/27/2022] [Indexed: 11/19/2022]
Abstract
Introduction Modern radiation therapy has become an effective method to treat and monitor tumour growth in cancer patients. It has proved to be a successful way to minimise mortality rates. However, the adverse effects of radiation have been historical evidence in the clinical environment involving diminishing the quality and density of bone and causing fragility fracture to the bone in the long run. This systematic review was aimed at identifying and evaluating the effects of irradiation on morphology and mechanical properties of murine model bone in previous publications. Methods A systematic literature review was undertaken following the Preferred Reporting Items for Systemic Reviews and Meta-analysis (PRISMA) guidelines. A comprehensive literature search was performed using Scopus, Web of Science, and Science Direct databases (English only studies published between 2015 and 2020). The selected studies were evaluated according to three criteria: (1) criteria for study sample selection; (2) criteria for methodological procedures; and (3) criteria for detection and evaluation. Results The initial search strategy identified 1408 related studies, 8 of were included based on inclusion and exclusion criteria. This review revealed an association between bone destruction and the magnitude of time and dose postirradiation. We agreed that the effect of radiation on bone morphology and strength primarily is a later stage event but noticeable in both low (1 Gy) and high dose (30 Gy) radiation. Trabecular and cortical bone microstructures were significantly altered at irradiation and contralateral sites. Besides, the mechanical strength was significantly impacted in both shorter and longer periods. Conclusion Overall, the radiotherapy altered bone microstructures and substantially decreases bone mechanical properties. The alteration was related to quantity and the activity of the osteoblast and osteoclast. Early detection of those most at risk for radiation-induced bone alterations could lead to better prophylactic intervention decisions.
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Júnior LHF, Limirio PHJO, Soares PBF, Dechichi P, de Souza Castro Filice L, Quagliatto PS, Rocha FS. The effect of hyperbaric oxygen therapy on bone macroscopy, composition and biomechanical properties after ionizing radiation injury. Radiat Oncol 2020; 15:95. [PMID: 32375798 PMCID: PMC7201996 DOI: 10.1186/s13014-020-01542-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/22/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Radiotherapy used in tumor treatment compromises vascularization of bone tissue. Hyperbaric oxygenation (HBO) increases oxygen availability and improves vascularization, minimizing the deleterious effects of ionizing radiation (IR). Therefore, the aim of this study was to evaluate HBO therapy effect on bone macroscopy, composition and biomechanical properties after IR damage. METHODS Twenty male Wistar rats weighing 300 ± 20 g (10 weeks of age) were submitted to IR (30 Gy) to the left leg, where the right leg was not irradiated. After 30 days, ten animals were submitted to HBO therapy, which was performed daily for 1 week at 250 kPa for 90-min sessions. All animals were euthanized 37 days after irradiation and the tibia were separated into four groups (n = 10): from animals without HBO - right tibia Non-irradiated (noIRnoHBO) and left tibia Irradiated (IRnoHBO); and from animals with HBO - right tibiae Non-irradiated (noIRHBO) and left tibia Irradiated (IRHBO). The length (proximal-distal) and thickness (anteroposterior and mediolateral) of the tibiae were measured. Biomechanical analysis evaluated flexural strength and stiffness. Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy (ATR-FTIR) was used to calculate the amide I ratio, crystallinity index, and matrix to mineral ratios. RESULTS In the macroscopic and ATR-FTIR analysis, the IRnoHBO showed lower values of length, thickness and amide I ratio, crystallinity index and matrix to mineral ratios compared to noIRnoHBO (p < 0.03). IRnoHBO showed no statistical difference compared to IRHBO for these analyses (p > 0.05). Biomechanics analysis showed that the IRnoHBO group had lower values of flexural strength and stiffness compared to noIRnoHBO and IRHBO groups (p < 0.04). In addition, the noIRHBO group showed higher value of flexural strength when compared to noIRnoHBO and IRHBO groups (p < 0.02). CONCLUSIONS The present study concluded that IR arrests bone development, decreases the collagen maturation and mineral deposition process, thus reducing the flexural strength and stiffness bone mechanical parameters. Moreover, HBO therapy minimizes deleterious effects of irradiation on flexural strength and the bone stiffness analysis.
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Affiliation(s)
- Luiz Henrique Ferreira Júnior
- Integrated Dental Clinic Program, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais 38.400-902 Brazil
| | - Pedro Henrique Justino Oliveira Limirio
- Integrated Dental Clinic Program, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais 38.400-902 Brazil
| | - Priscilla Barbosa Ferreira Soares
- Department of Periodontology and Oral Implantology, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/nº, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais 38.400-902 Brazil
| | - Paula Dechichi
- Department of Cell Biology, Histology and Embryology, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/nº, Campus Umuarama, Bloco 2B, Bairro Umuarama, Uberlândia, Minas Gerais 38.400-902 Brazil
| | - Letícia de Souza Castro Filice
- Department of Clinical Medicine, Histology and Embryology, Faculty of Medicine, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4U, Bairro Umuarama, Uberlândia, Minas Gerais 38.400-902 Brazil
| | - Paulo Sérgio Quagliatto
- Department of Dentistry and Dental Materials, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/nº, Campus Umuarama, Bloco 2B, Bairro Umuarama, Uberlândia, Minas Gerais 38.400-902 Brazil
| | - Flaviana Soares Rocha
- Department of Oral and Maxillofacial Surgery and Traumatology and Implantology, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/nº, Campus Umuarama, Bloco 2B, Bairro Umuarama, Uberlândia, Minas Gerais 38.400-902 Brazil
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Horváthy DB, Szántó P, Marschall B, Bagó M, Csery M, Hornyák I, Doros A, Lacza Z. Ketamine decreases cell viability of bone explants and impairs bone healing in rats. J Orthop Surg Res 2020; 15:46. [PMID: 32046745 PMCID: PMC7014735 DOI: 10.1186/s13018-020-1579-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Ketamine is a widely used anesthetic in experimental medicine. We have also used ketamine for surgical interventions and imaging in rats and found significantly impaired ossification between identically performed experiments, which only differed in the number of anesthetic events. In order to investigate this phenomenon, we estimated the absorbed ionizing radiation and also studied whether ketamine administration has disadvantageous effect on bone cell viability. Methods Spongious bone chips and parietal bone disks were harvested from rats. Explants were incubated in stem cell media containing 0.02, 0.2 and 2 mM ketamine. After 3 days of incubation, tetrazolium-based spectrophotometric assay was performed to measure cell viability. Size-specific dose estimation was used to calculate ionizing radiation of computed tomography imaging. Results We found that ketamine supplementation with 0.2 mM slightly decreased cell viability, while 2 mM caused significant reduction both in the spongious and cortical explants. The cumulative ionizing radiation was found to be negligible compared to irradiation dosages used to impair ossification. Conclusions We conclude that multiple ketamine administration was responsible for the diminished regenerative potential of bone tissue in the present experimental setup. For this reason, we suggest that ketamine anesthesia should be avoided in studies investigating bone regeneration.
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Affiliation(s)
- Dénes B Horváthy
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary. .,Department of Transplantation and Surgery, Semmelweis University, 23-25., Baross str, Budapest, H-1082, Hungary.
| | - Péter Szántó
- National Koranyi Institute for Pulmonology, Budapest, Hungary
| | - Bence Marschall
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - Marcell Bagó
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - Márton Csery
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - István Hornyák
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - Attila Doros
- Department of Transplantation and Surgery, Semmelweis University, 23-25., Baross str, Budapest, H-1082, Hungary
| | - Zsombor Lacza
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary.,University of Physical Education, Budapest, Hungary
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Limirio PHJO, Soares PBF, Emi ETP, Lopes CDCA, Rocha FS, Batista JD, Rabelo GD, Dechichi P. Ionizing radiation and bone quality: time-dependent effects. Radiat Oncol 2019; 14:15. [PMID: 30670063 PMCID: PMC6343359 DOI: 10.1186/s13014-019-1219-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 01/14/2019] [Indexed: 12/31/2022] Open
Abstract
Background The aim of this study was to evaluate the ionizing radiation (IR) effects on rat bone 30 and 60 days after irradiation. Methods Wistar rats were submitted to IR (30 Gy) on the left leg and were euthanized after 30 and 60 days. The legs were divided into four groups according to the treatment and euthanization time: C30 and C60 (right leg–without IR), IR30 and IR60 (left leg-with IR). Results CT analysis showed more radiodensity in C60 compared with other groups, and IR60 showed more radiodensity than IR30. In histomorphometric analysis, C30 showed lower bone matrix values compared with IR30 and C60. Lacunarity analyses showed more homogeneous bone channel distribution in C30 than IR30. ATR-FTIR showed decrease in ratio of mature and immature crosslinks in IR30 compared with C30. Crystallinity Index was decrease in IR60 compared with C60. The Amide III + Collagen/HA ratio was increased in C60 compared with C30; however this ratio decreased in IR60 compared with IR30. Biomechanical analysis showed lower values in IR groups in both time. Conclusions IR damaged bone quality and decreased stiffness. Moreover, the results suggested that the deleterious effects of IR increased in the late time points.
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Affiliation(s)
- Pedro Henrique Justino Oliveira Limirio
- Integrated Dental Clinic Program, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38.400-902, Brazil
| | - Priscilla Barbosa Ferreira Soares
- Integrated Dental Clinic Program, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38.400-902, Brazil
| | - Eduardo Tadashi Pinto Emi
- Integrated Dental Clinic Program, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38.400-902, Brazil
| | - Camila de Carvalho Almança Lopes
- Integrated Dental Clinic Program, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38.400-902, Brazil
| | - Flaviana Soares Rocha
- Integrated Dental Clinic Program, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38.400-902, Brazil
| | - Jonas Dantas Batista
- Integrated Dental Clinic Program, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38.400-902, Brazil
| | - Gustavo Davi Rabelo
- Faculty of Dentistry, Federal University of Juiz de Fora, Faculdade de Odontologia - Campus Universitário - Bairro Martelos -, Juiz de Fora, Minas Gerais, 36036-300, Brazil
| | - Paula Dechichi
- Integrated Dental Clinic Program, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38.400-902, Brazil.
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Soares PBF, Soares CJ, Limirio PHJO, de Jesus RNR, Dechichi P, Spin-Neto R, Zanetta-Barbosa D. Effect of ionizing radiation after-therapy interval on bone: histomorphometric and biomechanical characteristics. Clin Oral Investig 2018; 23:2785-2793. [PMID: 30368663 DOI: 10.1007/s00784-018-2724-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/18/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This study aimed to evaluate the effects of radiotherapy on biomechanical, histomorphometric, and microstructural characteristics of bone, in diverse periods, compared with intact bone tissue. MATERIALS AND METHODS Eighteen adult male New Zealand rabbits were treated with a single radiation dose of 30 Gy. The animals were randomly divided into six groups: NoIr, control group, no radiation, and five irradiated groups sacrificed after 24 h (Ir24h), 7 (Ir7d), 14 (Ir14d), 21 (Ir21d), and 28 (Ir28d) days. After these periods, the animals were sacrificed and their tibias (n = 6) evaluated using three-point bending test to calculate the ultimate force, work to failure, and bone stiffness. Dynamic indentation test was used to quantify Vickers hardness and elasticity modulus of bone tissue. Micro-CT was used to analyze the cortical volume (CtV), cortical thickness (CtTh), and porosity (Ct.Po). Histomorphometric assessment was based on the lacunarity of bone tissue. Data were analyzed using one-way ANOVA and Kruskal-Wallis tests followed by Tukey, Dunnet, and Dunn's post-tests (P < 0.05). RESULTS The ultimate force, work to failure, stiffness, elastic modulus, and Vickers hardness values of irradiated bone were significantly lower that non-irradiated bone. Irradiated bone showed significantly lower CtTh and CtV values and higher CtPo than non-irradiated bone. No significant difference was found for lacunarity between non-irradiated bone and irradiated bone. CONCLUSIONS Ionizing radiation decreases normal anisotropy on microarchitecture of cortical bone, and increases bone fragility compared with non-irradiated bone. Further, these changes were seen after longer periods (e.g., 14 and 21 days), and not immediately after radiation therapy. CLINICAL RELEVANCE The radiotherapy reduces bone mechanical properties and the normal structure of organic and inorganic bone matrix. For studying the protocols to protect the radiotherapy effect using rabbit model, the use of the sacrificing period between 14 and 21 days is recommended.
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Affiliation(s)
- Priscilla Barbosa Ferreira Soares
- Department of Periodontology and Implantology, School of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38400-902, Brazil.
| | - Carlos José Soares
- Department of Operative Dentistry and Dental Materials, School of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Pedro Henrique Justino Oliveira Limirio
- Department of Periodontology and Implantology, School of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Rainde Naiara Rezende de Jesus
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4T, Bairro Umuarama, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Paula Dechichi
- Institute of Biomedical Sciences, Federal University of Uberlândia, Avenida Pará 1720, Campus Umuarama, Bloco 2B, Bairro Umuarama, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Rubens Spin-Neto
- Department of Dentistry and Oral Health, Department of Oral Radiology, Aarhus University, Vennelyst Boulevard 9, Building 1613, 130, 8000, Aarhus C, Denmark
| | - Darceny Zanetta-Barbosa
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4T, Bairro Umuarama, Uberlândia, Minas Gerais, 38400-902, Brazil
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