Periodontal disease might be a risk factor for graft versus host disease. A systematic review

Effectiveness evaluation of autotransplanted teeth after performing extraoral endodontic surgery instead of conventional root canal therapy

PURPOSE

The aim of this study was to examine the viability and efficacy of utilizing extraoral apicoectomy and retrograde filling in combination to seal the root canal system of mature molars without the need for root canal therapy (RCT) during the autotransplantation of teeth (ATT).

MATERIALS AND METHODS

This study screened 27 patients who received ATT at the Department of Oral Surgery in the Hospital of Stomatology from 2019 to 2021. Extraoral apicoectomy and retrograde filling were performed, while RCT was temporarily not performed. The study analysed the periodontal status and masticatory function of transplanted teeth one to three years postoperation and used cone-beam computed tomography (CBCT) and periapical radiograph (PA) to evaluate the integrity of the periodontal space and intra/periapical inflammation. The potential predictors of survival/success were analysed statistically. We also conducted questionnaires and chewing efficiency tests.

RESULTS

In this study, 27 TTs from 27 patients were found to be fully functional in terms of chewing ability. The overall survival rate was 100% (27/27), and the success rate was 70.4% (19/27). A total of 90.9% (20/22) of patients reported being satisfied or very satisfied with their TTs. Additionally, the chewing efficiency of the transplantation side was on average 82.0% of that of the healthy side, with a significant difference between the two sides (P < 0.05). None of the potential predictors were found to significantly affect the success or survival of the transplanted tooth (TT).

CONCLUSION

The combination of extraoral apicoectomy and retrograde filling in TT showed promising outcomes, but further clinical cases and longer follow-up times are still required to validate the treatment plan.

Circulating miRNAs as Epigenetic Mediators of Periodontitis and Preeclampsia Association

Objective

Periodontal disease has been associated with pregnancy complications including preeclampsia. This bioinformatic study is aimed at investigating the possible role of circulating microRNAs (miRNAs) as mediators of the association between maternal periodontal disease and preeclampsia.

Methods

Peripheral blood miRNA profiles of periodontitis and controls were sought from Gene Expression Omnibus (GEO), and differential expression analysis was performed. Experimentally validated circulating miRNAs associated with preeclampsia were determined from the Human MicroRNA Disease Database (HMDD v3.0). Venn diagrams were drawn to identify shared circulating differential miRNAs (DEmiRNAs). Significantly enriched target genes, KEGG pathways, and Gene Ontology (GO) terms for the set of shared DEmiRNA were predicted using miRNA enrichment analysis and annotation tool (miEAA v 2.0). Additionally, the shared DEmiRNA-enriched target genes were analyzed for enriched WikiPathways, BioCarta metabolic pathways, and tissue proteins in the human proteome map.

Results

Among 183 circulating DEmiRNA in periodontitis and 60 experimentally validated miRNA in preeclampsia, 9 shared DEmiRNA were identified. The top among 32 overrepresented target genes included MAFB, PSAP, and CDK5RAP2, top among 14 enriched KEGG pathways were renin-angiotensin system and graft-versus-host disease, and that among enriched 44 GO profiles included “positive regulation of epidermal growth factor-activated receptor activity” and “sequestering of calcium ion.” In the overrepresented target gene set, among 10 enriched WikiPathways, the top included “NAD metabolism, sirtuins, and aging” and “regulation of Wnt/B-catenin signaling by small molecule compounds” and PPAR-related mechanisms was top among 13 enriched BioCarta metabolic pathways.

Conclusion

A circulating 9-DEmiRNA set was significantly linked to both periodontitis and preeclampsia. Enrichment analysis identified specific genes, pathways, and functional mechanisms, which may be epigenetically altered and thereby mediate the biological association of periodontitis and preeclampsia.

Structural Changes in Resin-Based Composites in Saliva of Patients with Leukemia before Starting Chemotherapeutic Regimen

Background: The aim of this in vitro study was to assess the morphological characteristics and stability of dental composites immersed in saliva collected from patients with leukemia. Material and Methods: A total number of five patients without systemic disease and 20 patients with leukemia (acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), and chronic myeloid leukemia (CML)) were included for saliva sampling. Composite disks were immersed in the leukemia, control, and artificial environments for 7 days. At the end of the experiment, atomic force microscopy (AFM), color stability (ΔE), and saliva elements analysis were performed. Statistical significance was considered for a p-value under 0.05. Results: The most changed surface resulted for ALL with a roughness that was almost double that of the untreated sample and was significantly increased compared to the healthy saliva. The effect of CLL was not as intense as observed for acute leukemia, but was significantly over the control. ALL seemed to modify structural components of the saliva, which were able to deteriorate the surface of the composite. ALL saliva promoted a significant dissolution of the initial feature of the samples and promoted nano-particle clusterization. All dental composites showed clinically acceptable color change values (ΔE < 3.3) in all four-leukemia salivas; CLL and CML showed large color differences for all composites. The total concentrations of P, Na, and K showed wide ranges of variations, while the coefficient of variation in Fe, Cu, and Mg showed narrow variations between the salvias’ investigated. The salivary concentration of zinc decreased considerably in the CLL and CML environments compared to the ALL and AML environments. Fe and Cu were significantly increased in the CML environment. Conclusions: Control and artificial salivas have a mild erosive effect on the surface of dental composites. The acute stage of the disease seems to deteriorate the surface roughness rather than its morphology, however, in the chronic stage, it is the surface morphology that mostly deteriorates.

Characteristics of Dental Resin-Based Composites in Leukemia Saliva: An In Vitro Analysis

BACKGROUND

The aim was to analyze, in vitro, four resin based composite systems (RBCs) immersed in saliva of leukemia patients before starting chemotherapy regiments.

MATERIAL AND METHODS

Saliva was collected from 20 patients (4 healthy patients, 16 leukemia patients). Resin disks were made for each RBC and were immersed in the acute leukemia (acute lymphocytic (ALL), acute myeloid (AML)), chronic leukemia (chronic lymphocytic (CLL), chronic myeloid (CML)), Artificial saliva and Control environment, and maintained for seven days. At the end of the experiment, the characteristics and the effective response of saliva from the studied salivas' on RBCs was assessed using water sorption, water solubility, residual monomer and scanning electron microscopy (SEM). Data analysis was performed and a p-value under 0.05 was considered statistically significant.

RESULTS

The behaviour of RBCs in different immersion environments varies according to the characteristics of the RBCs. RBCs with a higher filler ratio have a lower water sorption. The solubility is also deteriorated by the types of organic matrix and filler; the results of solubility being inversely proportional on the scale of negative values compared to sorption values. Chromatograms of residual monomers showed the highest amount of unreacted monomers in ALL and AML, and the Control and artificial saliva environments had the smallest residual monomer peaks. Because of the low number of differences between the experimental conditions, we further considered that there were no important statistical differences between experimental conditions and analysed them as a single group.

CONCLUSION

The influence of saliva on RBCs depends on the type of leukemia; acute leukemia influenced the most RBCs by changing their properties compared to chronic leukemia.

National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2020 Etiology and Prevention Working Group Report

Preventing chronic graft-versus-host disease (GVHD) remains challenging because the unique cellular and molecular pathways that incite chronic GVHD are poorly understood. One major point of intervention for potential prevention of chronic GVHD occurs at the time of transplantation when acute donor anti-recipient immune responses first set the events in motion that result in chronic GVHD. After transplantation, additional insults causing tissue injury can incite aberrant immune responses and loss of tolerance, further contributing to chronic GVHD. Points of intervention are actively being identified so that chronic GVHD initiation pathways can be targeted without affecting immune function. The major objective in the field is to continue basic studies and to translate what is learned about etiopathology to develop targeted prevention strategies that decrease the risk of morbid chronic GVHD without increasing the risks of cancer relapse or infection. Development of strategies to predict the risk of developing debilitating or deadly chronic GVHD is a high research priority. This working group recommends further interrogation into the mechanisms underpinning chronic GVHD development, and we highlight considerations for future trial design in prevention trials.

Oral chronic graft-versus-host disease: What the general dental practitioner needs to know

BACKGROUND

Long-term survivors of allogeneic hematopoietic cell transplantation will increasingly seek care from dental providers.

METHODS

The authors highlight the importance of minimizing oral symptoms and complications associated with oral chronic graft-versus-host-disease (cGVHD).

RESULTS

Chronic GVHD is the result of an immune response of donor-derived cells against recipient tissues. Oral cGVHD can affect the mucosa and damage salivary glands and cause sclerotic changes. Symptoms include sensitivity and pain, dry mouth, taste changes, and limited mouth opening. Risk of developing caries and oral cancer is increased. Food intake, oral hygiene, and dental interventions can represent challenges. Oral cGVHD manifestations and dental interventions should be managed in close consultation with the medical team, as systemic treatment for cGVHD can have implications for dental management.

CONCLUSIONS

General dental practitioners can contribute substantially to alleviating oral cGVHD involvement and preventing additional oral health deterioration.

PRACTICAL IMPLICATIONS

Frequent examinations, patient education, oral hygiene reinforcement, dry mouth management, caries prevention, and management of dental needs are indicated. In addition, oral physical therapy might be needed. Invasive dental interventions should be coordinated with the transplantation team. Screening for oral malignancies is important even years after resolution of GVHD symptoms. Management of the oral manifestations of cGVHD might require referral to an oral medicine professional.

Topical Corticosteroids a Viable Solution for Oral Graft Versus Host Disease? A Systematic Insight on Randomized Clinical Trials

Background and Objectives: This research attempts to provide a clear view of the literature on randomized clinical trials (RCTs) concerning the efficacy of topical dexamethasone, clobetasol and budesonide in oral graft versus host disease (GVHD). Materials and Methods: An electronic search of the PubMed, Web of Science and Scopus databases was carried out for eligible RCTs. Studies were included if they had adult patients with oral GVHD treatment with topical corticosteroids, and if the RCT study was published in English. The Cochrane Risk of Bias tool was used to assess the quality of these studies. Overall, three RCTs were included (an Open, Randomized, Multicenter Trial; a Randomized Double-Blind Clinical Trial; and an Open-Label Phase II Randomized Trial). Results: The trials involved 76 patients, of which 44 patients received topical dexamethasone, 14 patients received topical clobetasol and 18 patients received topical budesonide. Topical agents were most frequently used when oral tissues were the sole site of involvement. It appears that the best overall response is present for budesonide with no difference between the four arms, followed by clobetasol, and then by dexamethasone. The limitation of the current study is mainly represented by the fact that overall response was derived in two of the studies from other parameters. Moreover, both budesonide and clobetasol were used in only one study each, while two assessed dexamethasone. Conclusions: Based on the clinical trials, all three agents seem to be effective in treating oral GVHD and had a satisfactory safety profile. There is still a need for assessing high quality RCTs to assess the efficacy of these therapies on a larger cohort.

A systematic approach on the frequency of cleft lip/palate in pediatric patients with leukemia

PURPOSE

The purpose of this study was to reveal the frequency between cleft lip/palate and leukemia in pediatric patients by a systematic analysis of the current literature.

MATERIALS AND METHODS

Electronic search on three database (PubMed, Web of Science, Cochrane) was carried out using the following keywords: cleft lip, cleft palate, facial cleft, oral cleft, orofacial cleft, leukemia, acute myeloid leukemia, acute lymphocytic leukemia, lymphoma. Studies published until March 2020 reporting an association between leukemia and cleft lip/palate (CL/P) were included in our research.

RESULTS

Five articles (2 case-controls, 3 cohorts), met the inclusion criteria. Case-control studies involved 268 patients with acute lymphocytic leukemia (ALL) and 177 patients with acute myeloid leukemia (AML), of which 9 patients had CL/P. The cohorts studies involved 10 patients with ALL, of which 6 patients with CL/P, 2 patients with cleft palate and 1 patient with cleft lip and palate.

CONCLUSION

This research was able to indicate a limited evidence of the association between CL/P and leukemia. In order to draw a clear conclusion, studies with larger cohorts are needed to establish this correlation.