1
|
Han Z, Xiong J, Jin X, Dai Q, Han M, Wu H, Yang J, Tang H, He L. Advances in reparative materials for infectious bone defects and their applications in maxillofacial regions. J Mater Chem B 2024; 12:842-871. [PMID: 38173410 DOI: 10.1039/d3tb02069j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Infectious bone defects are characterized by the partial loss or destruction of bone tissue resulting from bacterial contaminations subsequent to diseases or external injuries. Traditional bone transplantation and clinical methods are insufficient in meeting the treatment demands for such diseases. As a result, researchers have increasingly focused on the development of more sophisticated biomaterials for improved therapeutic outcomes in recent years. This review endeavors to investigate specific reparative materials utilized for the treatment of infectious bone defects, particularly those present in the maxillofacial region, with a focus on biomaterials capable of releasing therapeutic substances, functional contact biomaterials, and novel physical therapy materials. These biomaterials operate via heightened antibacterial or osteogenic properties in order to eliminate bacteria and/or stimulate bone cells regeneration in the defect, ultimately fostering the reconstitution of maxillofacial bone tissue. Based upon some successful applications of new concept materials in bone repair of other parts, we also explore their future prospects and potential uses in maxillofacial bone repair later in this review. We highlight that the exploration of advanced biomaterials holds promise in establishing a solid foundation for the development of more biocompatible, effective, and personalized treatments for reconstructing infectious maxillofacial defects.
Collapse
Affiliation(s)
- Ziyi Han
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - Jingdi Xiong
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - Xiaohan Jin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - Qinyue Dai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - Mingyue Han
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - Hongkun Wu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - Jiaojiao Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - Haiqin Tang
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, P. R. China
| | - Libang He
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| |
Collapse
|
2
|
Eggers B, Stope MB, Marciniak J, Mustea A, Eick S, Deschner J, Nokhbehsaim M, Kramer FJ. Non-Invasive Physical Plasma Reduces the Inflammatory Response in Microbially Prestimulated Human Gingival Fibroblasts. Int J Mol Sci 2023; 24:16156. [PMID: 38003346 PMCID: PMC10671174 DOI: 10.3390/ijms242216156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Non-invasive physical plasma (NIPP), an electrically conductive gas, is playing an increasingly important role in medicine due to its antimicrobial and regenerative properties. However, NIPP is not yet well established in dentistry, although it has promising potential, especially for periodontological applications. The aim of the present study was to investigate the effect of NIPP on a commercially available human gingival fibroblast (HGF) cell line and primary HGFs in the presence of periodontitis-associated bacteria. First, primary HGFs from eight patients were characterised by immunofluorescence, and cell numbers were examined by an automatic cell counter over 5 days. Then, HGFs that were preincubated with Fusobacterium nucleatum (F.n.) were treated with NIPP. Afterwards, the IL-6 and IL-8 levels in the cell supernatants were determined by ELISA. In HGFs, F.n. caused a significant increase in IL-6 and IL-8, and this F.n.-induced upregulation of both cytokines was counteracted by NIPP, suggesting a beneficial effect of physical plasma on periodontal cells in a microbial environment. The application of NIPP in periodontal therapy could therefore represent a novel and promising strategy and deserves further investigation.
Collapse
Affiliation(s)
- Benedikt Eggers
- Department of Oral, Maxillofacial and Plastic Surgery, University Hospital Bonn, 53111 Bonn, Germany;
| | - Matthias Bernhard Stope
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.B.S.); (A.M.)
| | - Jana Marciniak
- Department of Orthodontics, University Hospital Bonn, 53111 Bonn, Germany;
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.B.S.); (A.M.)
| | - Sigrun Eick
- Department of Periodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland;
| | - James Deschner
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany;
| | - Marjan Nokhbehsaim
- Section of Experimental Dento-Maxillo-Facial Medicine, University Hospital Bonn, 53111 Bonn, Germany;
| | - Franz-Josef Kramer
- Department of Oral, Maxillofacial and Plastic Surgery, University Hospital Bonn, 53111 Bonn, Germany;
| |
Collapse
|
3
|
Songca SP. Combinations of Photodynamic Therapy with Other Minimally Invasive Therapeutic Technologies against Cancer and Microbial Infections. Int J Mol Sci 2023; 24:10875. [PMID: 37446050 DOI: 10.3390/ijms241310875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
The rapid rise in research and development following the discovery of photodynamic therapy to establish novel photosensitizers and overcome the limitations of the technology soon after its clinical translation has given rise to a few significant milestones. These include several novel generations of photosensitizers, the widening of the scope of applications, leveraging of the offerings of nanotechnology for greater efficacy, selectivity for the disease over host tissue and cells, the advent of combination therapies with other similarly minimally invasive therapeutic technologies, the use of stimulus-responsive delivery and disease targeting, and greater penetration depth of the activation energy. Brought together, all these milestones have contributed to the significant enhancement of what is still arguably a novel technology. Yet the major applications of photodynamic therapy still remain firmly located in neoplasms, from where most of the new innovations appear to launch to other areas, such as microbial, fungal, viral, acne, wet age-related macular degeneration, atherosclerosis, psoriasis, environmental sanitization, pest control, and dermatology. Three main value propositions of combinations of photodynamic therapy include the synergistic and additive enhancement of efficacy, the relatively low emergence of resistance and its rapid development as a targeted and high-precision therapy. Combinations with established methods such as chemotherapy and radiotherapy and demonstrated applications in mop-up surgery promise to enhance these top three clinical tools. From published in vitro and preclinical studies, clinical trials and applications, and postclinical case studies, seven combinations with photodynamic therapy have become prominent research interests because they are potentially easily applied, showing enhanced efficacy, and are rapidly translating to the clinic. These include combinations with chemotherapy, photothermal therapy, magnetic hyperthermia, cold plasma therapy, sonodynamic therapy, immunotherapy, and radiotherapy. Photochemical internalization is a critical mechanism for some combinations.
Collapse
Affiliation(s)
- Sandile Phinda Songca
- School of Chemistry and Physics, College of Agriculture Engineering and Science, Pietermaritzburg Campus, University of KwaZulu-Natal, Pietermaritzburg 3209, South Africa
| |
Collapse
|
4
|
Applications of Antimicrobial Photodynamic Therapy against Bacterial Biofilms. Int J Mol Sci 2022; 23:ijms23063209. [PMID: 35328629 PMCID: PMC8953781 DOI: 10.3390/ijms23063209] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 12/14/2022] Open
Abstract
Antimicrobial photodynamic therapy and allied photodynamic antimicrobial chemotherapy have shown remarkable activity against bacterial pathogens in both planktonic and biofilm forms. There has been little or no resistance development against antimicrobial photodynamic therapy. Furthermore, recent developments in therapies that involve antimicrobial photodynamic therapy in combination with photothermal hyperthermia therapy, magnetic hyperthermia therapy, antibiotic chemotherapy and cold atmospheric pressure plasma therapy have shown additive and synergistic enhancement of its efficacy. This paper reviews applications of antimicrobial photodynamic therapy and non-invasive combination therapies often used with it, including sonodynamic therapy and nanozyme enhanced photodynamic therapy. The antimicrobial and antibiofilm mechanisms are discussed. This review proposes that these technologies have a great potential to overcome the bacterial resistance associated with bacterial biofilm formation.
Collapse
|
5
|
Wagner G, Eggers B, Duddeck D, Kramer FJ, Bourauel C, Jepsen S, Deschner J, Nokhbehsaim M. Influence of cold atmospheric plasma on dental implant materials - an in vitro analysis. Clin Oral Investig 2021; 26:2949-2963. [PMID: 34907458 PMCID: PMC8898257 DOI: 10.1007/s00784-021-04277-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/01/2021] [Indexed: 12/25/2022]
Abstract
Background and objectives Alterations in the microenvironment of implant surfaces could influence the cellular crosstalk and adhesion patterns of dental implant materials. Cold plasma has been described to have an influence on cells, tissues, and biomaterials. Hence, the mechanisms of osseointegration may be altered by non-thermal plasma treatment depending on different chemical compositions and surface coatings of the biomaterial. The aim of the present study is to investigate the influence of cold atmospheric plasma (CAP) treatment on implant surfaces and its biological and physicochemical side effects. Materials and methods Dental implant discs from titanium and zirconia with different surface modifications were treated with CAP at various durations. Cell behavior and adhesion patterns of human gingival fibroblast (HGF-1) and osteoblast-like cells (MG-63) were examined using scanning electron microscopy and fluorescence microscopy. Surface chemical characterization was analyzed using energy-dispersive X-ray spectroscopy (EDS). Quantitative analysis of cell adhesion, proliferation, and extracellular matrix formation was conducted including real-time PCR. Results CAP did not affect the elemental composition of different dental implant materials. Additionally, markers for cell proliferation, extracellular matrix formation, and cell adhesion were differently regulated depending on the application time of CAP treatment in MG-63 cells and gingival fibroblasts. Conclusions CAP application is beneficial for dental implant materials to allow for faster proliferation and adhesion of cells from the surrounding tissue on both titanium and zirconia implant surfaces with different surface properties. Clinical relevance The healing capacity provided through CAP treatment could enhance osseointegration of dental implants and has the potential to serve as an effective treatment option in periimplantitis therapy.
Collapse
Affiliation(s)
- Gunar Wagner
- Department of Periodontology, Operative and Preventive Dentistry, Center of Dento-Maxilo-Facial Medicine, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany.
| | - Benedikt Eggers
- Department of Oral Surgery, Center of Dento-Maxillo-Facial Medicine, University of Bonn, 53111, Bonn, Germany
| | - Dirk Duddeck
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, University Charité Berlin, 14197, Berlin, Germany.,Research Department, CleanImplant Foundation, 10117, Berlin, Germany
| | - Franz-Josef Kramer
- Department of Oral Surgery, Center of Dento-Maxillo-Facial Medicine, University of Bonn, 53111, Bonn, Germany.,Department of Cranio-Maxillofacial Surgery, Center of Dento-Maxillo-Facial Medicine, University of Bonn, 53111, Bonn, Germany
| | - Christoph Bourauel
- Department of Oral Technology, School of Dentistry, University of Bonn, 53111, Bonn, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, Center of Dento-Maxilo-Facial Medicine, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany
| | - James Deschner
- Department of Periodontology and Operative Dentistry, University of Mainz, 55131, Mainz, Germany
| | - Marjan Nokhbehsaim
- Section of Experimental Dento-Maxillo-Facial Medicine, Center of Dento-Maxillo-Facial Medicine, University of Bonn, 53111, Bonn, Germany
| |
Collapse
|
6
|
Rao Y, Shang W, Yang Y, Zhou R, Rao X. Fighting Mixed-Species Microbial Biofilms With Cold Atmospheric Plasma. Front Microbiol 2020; 11:1000. [PMID: 32508796 PMCID: PMC7251026 DOI: 10.3389/fmicb.2020.01000] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/24/2020] [Indexed: 01/05/2023] Open
Abstract
Most biofilms in nature are formed by multiple microbial species, and such mixed-species biofilms represent the actual lifestyles of microbes, including bacteria, fungi, viruses (phages), and/or protozoa. Microorganisms cooperate and compete in mixed-species biofilms. Mixed-species biofilm formation and environmental resistance are major threats to water supply, food industry, and human health. The methods commonly used for microbial eradication, such as antibiotic or disinfectant treatments, are often ineffective for mixed-species biofilm consortia due to their physical matrix barrier and physiological interactions. For the last decade, an increasing number of investigations have been devoted to the usage of cold atmospheric plasma (CAP), which is produced by dielectric barrier discharges or plasma jets to prevent or eliminate microbial biofilms. Here, we summarized the production of CAP, the inactivation of microorganisms upon CAP treatment, and the microbial factors affecting the efficacy of CAP procedure. The applications of CAP as antibiotic alternative strategies for fighting mixed-species biofilms were also addressed.
Collapse
Affiliation(s)
- Yifan Rao
- Department of Microbiology, College of Basic Medical Sciences, Key Laboratory of Microbial Engineering Under the Educational Committee in Chongqing, Army Medical University, Chongqing, China
| | - Weilong Shang
- Department of Microbiology, College of Basic Medical Sciences, Key Laboratory of Microbial Engineering Under the Educational Committee in Chongqing, Army Medical University, Chongqing, China
| | - Yi Yang
- Department of Microbiology, College of Basic Medical Sciences, Key Laboratory of Microbial Engineering Under the Educational Committee in Chongqing, Army Medical University, Chongqing, China
| | - Renjie Zhou
- Department of Emergency, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xiancai Rao
- Department of Microbiology, College of Basic Medical Sciences, Key Laboratory of Microbial Engineering Under the Educational Committee in Chongqing, Army Medical University, Chongqing, China
| |
Collapse
|
7
|
Cristina Da Silva F, Rosa LP, Santos GPDO, Inada NM, Blanco KC, Araújo TSD, Bagnato VS. Total mouth photodynamic therapy mediated by blue led and curcumin in individuals with AIDS. Expert Rev Anti Infect Ther 2020; 18:689-696. [PMID: 32336177 DOI: 10.1080/14787210.2020.1756774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To test the effectiveness of an efficient therapeutic protocol for the total mouth antimicrobial photodynamic therapy (aPDT) mediated by 450 nm blue LED associated with curcumin in individuals with AIDS. METHODS Patients were selected by exclusion criteria and randomly distributed in groups to test the effectiveness of antimicrobial aPDT with curcumin 0.75 mg/mL associated with the blue LED (67 mW/cm2, 20.1 J/cm2). Before and after the treatments, samples were collected from the saliva being processed in duplicate in selective culture media. The colonies were counted and the results obtained in log10 CFU/mL were statistically tested (T-paired statistical test, 5%). RESULTS The log10 CFU/mL of Streptococcus spp., Staphylococcus spp., and total count of microorganisms showed statistically significant (p = 0.023; p = 0.001 and p = 0.017, respectively) reduction after treatment in patients with aPDT. CONCLUSION aPDT was effective in reducing Streptococcusspp. in addition to reducing Staphylococcusspp., enterobacteria and the total count of microorganisms when considering the numbers of TCD4 and TCD8 lymphocytes. The aPDT in the studied protocol was able to control clinically important intraoral microorganisms for AIDS patients, both those with TCD4 lymphocytes above or below 25% of normal and those with TCD8 lymphocytes above 25% of normal.
Collapse
Affiliation(s)
| | - Luciano Pereira Rosa
- Federal University of Bahia, Multidisciplinary Health Institute , Vitória Da Conquista, BA, Brazil
| | | | | | | | | | | |
Collapse
|
8
|
Kniha K, Möhlhenrich SC, Bock A, Ayoub N, Modabber A, Hölzle F, Conrads G, Goloborodko E. Evaluation of the bactericidal effect of cold atmospheric pressure plasma on contaminated human bone: an in vitro study. Br J Oral Maxillofac Surg 2020; 58:329-333. [PMID: 31969253 DOI: 10.1016/j.bjoms.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/03/2020] [Indexed: 01/03/2023]
Abstract
The use of cold atmospheric pressure plasma (CAPP) as a bacterial decontaminant for chronic wounds has shown good results. The purpose of this in vitro study was to evaluate the bactericidal effects of CAPP on the cancellous area of the bone. Sterile glass slides and processed sterile human bone allografts 1, 2, 3, and 4mm thick were used for initial contamination and further CAPP treatment. Each block was contaminated with Staphylococcus aureus suspension on one side. Each slide was turned 180° and treated on the reverse side. The bacterial count in colony-forming units (CFU) was then measured and compared with that of a control group, and the bactericidal effects of CAPP in relation to bone density evaluated. A significant reduction in count was measured between treated and untreated groups (groups A-D: p<0.01 and group E: p=0.04). A strong positive linear relation was found between bone density and the S aureus count (r=0.844, p=0.156). Treatment with CAPP had a bactericidal effect on bone structures with a penetration depth of up to 4mm. It might be used for all diseases involving infected bone, and so extends the existing range of treatments.
Collapse
Affiliation(s)
- K Kniha
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelstraße 30, Germany.
| | - S C Möhlhenrich
- Department of Orthodontics, University Hospital Aachen, Germany
| | - A Bock
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelstraße 30, Germany
| | - N Ayoub
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelstraße 30, Germany
| | - A Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelstraße 30, Germany
| | - F Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelstraße 30, Germany
| | - G Conrads
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital RWTH Aachen, Pauwelstraße 30, Germany
| | - E Goloborodko
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelstraße 30, Germany
| |
Collapse
|
9
|
Tartaroti NC, Marques MM, Naclério-Homem MDG, Migliorati CA, Zindel Deboni MC. Antimicrobial photodynamic and photobiomodulation adjuvant therapies for prevention and treatment of medication-related osteonecrosis of the jaws: Case series and long-term follow-up. Photodiagnosis Photodyn Ther 2020; 29:101651. [PMID: 31923636 DOI: 10.1016/j.pdpdt.2020.101651] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/06/2019] [Accepted: 01/03/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Medication-Related Osteonecrosis of the Jaws (MRONJ) incidence are increasing among elderly. Treatment can be challenging. Prevent or treatment protocols that control evolution of the lesion are warranted. OBJECTIVE To observe long-term outcomes of two protocols based on photonics [antimicrobial photodynamic therapy (aPDT) and photobiomodulation (PBM)] for prevention and treatment of MRONJ lesions. METHODS In a prospective study, patients who needed oral surgery and had been exposed to antiresorptive drugs were long-term followed-up. For MRONJ prevention, immediately after tooth extraction aPDT was applied. For aPDT a 0.01 % methylene blue solution was applied inside socket for 5 min followed by irradiation with a diode laser [660 nm, 0.028cm2, 0.1 W, 3.57 W/cm2, 90 s and 9 J per point, 321 J/cm2, at least at in 3 points (laser probe was placed at central, and two equidistant points) and total energy of 27J]. Irradiation was repeated weekly until total tissue repair. MRONJ treatment included preoperative aPDT sessions until signs and symptoms of infection had reduced. Then, after necrotic bone removal, aPDT was applied inside surgical wounds and re-applied weekly until healing. Antibiotics were administered pre or postoperatively for no longer than 7 days. PBM therapy was applied with 808 nm diode laser, 0.028cm2, 0.1 W, 3.57 W/cm2, 30 s, 107 J/cm², 3 J and total energy of 12 J until evidence of remission. RESULTS Eighteen patients underwent preventive protocol, and none presented signs of MRONJ after a follow-up of at least 6 months. Seventeen patients presented with MRONJ underwent aPDT protocol and sixteen of them showed total regression of lesions. PRACTICAL IMPLICATIONS aPDT and PBM therapy protocols appear to be effective as adjuvant approach not only for preventing MRONJ development due to tooth extraction but for treating MRONJ lesions at early stages with no adverse effects.
Collapse
Affiliation(s)
- Natália Caroline Tartaroti
- Department of Oral and Maxillofacial Surgery- School of Dentistry - University of Sao Paulo FOUSP, Av. Prof. Lineu Prestes 2227, Butantã, São Paulo, 5508-000, São Paulo Brazil.
| | - Márcia Martins Marques
- Post Graduation Program - School of Dentistry - Ibirapuera University - UNIb, Av. Interlagos, 1329 - 4º - Chácara Flora, São Paulo, SP, 04661-100, Brazil.
| | - Maria da Graça Naclério-Homem
- Department of Oral and Maxillofacial Surgery- School of Dentistry - University of Sao Paulo FOUSP, Av. Prof. Lineu Prestes 2227, Butantã, São Paulo, 5508-000, São Paulo Brazil.
| | - Cesar Augusto Migliorati
- Department of Oral and Maxillofacial Diagnostic - University of Florida College of Dentistry, 1395 Center Drive, Rm D3-9 PO Box 100412 Gainesville, FL 32610-0412 USA.
| | - Maria Cristina Zindel Deboni
- Department of Oral and Maxillofacial Surgery- School of Dentistry - University of Sao Paulo FOUSP, Av. Prof. Lineu Prestes 2227, Butantã, São Paulo, 5508-000, São Paulo Brazil.
| |
Collapse
|