Predictivity of Standardized and Controlled Permeation Studies: Ex vivo - In vitro - In vivo Correlation for Sublingual Absorption of Propranolol

In preclinical drug development, ex vivo and in vitro permeability studies are a decisive element for specifying subsequent development steps. In this context, reliability, physiological alignment and appropriate in vivo correlation are mandatory for predictivity regarding drug absorption. Especially in oromucosal drug delivery, these prerequisites are not adequately met, which hinders its progressive development and results in the continuous need for animal experiments. To address current limitations, an innovative, standardized, and controlled ex vivo permeation model was applied. It is based on Kerski diffusion cells embedded in automated sampling and coupled to mass spectrometric quantification under physiologically relevant conditions. This study aimed to evaluate the predictivity of the developed model using porcine mucosa (ex vivo) in relation to data of sublingual propranolol absorption (in vivo). In addition, the usefulness of biomimetic barriers (in vitro) as a replacement for porcine mucosa was investigated. Therefore, solubility and permeability studies considering microenvironmental conditions were conducted and achieved good predictivity (R²=0.997) for pH-dependent permeability. A multiple level C correlation (R²≥0.860) between obtained permeability and reported pharmacokinetic animal data (AUC, C_max) was revealed. Furthermore, a point-to-point correlation was demonstrated for several sublingual formulations. The successful IVIVC confirms the standardized ex vivo model as a viable alternative to animal testing for estimating the in vivo absorption behavior of oromucosal pharmaceuticals.

Roles of Lipids in the Permeability Barriers of Skin and Oral Mucosa

PubMed searches reveal much literature regarding lipids in barrier function of skin and less literature on lipids in barrier function of the oral mucosa. In terrestrial mammals, birds, and reptiles, the skin’s permeability barrier is provided by ceramides, fatty acids, and cholesterol in the outermost layers of the epidermis, the stratum corneum. This layer consists of about 10–20 layers of cornified cells embedded in a lipid matrix. It effectively prevents loss of water and electrolytes from the underlying tissue, and it limits the penetration of potentially harmful substances from the environment. In the oral cavity, the regions of the gingiva and hard palate are covered by keratinized epithelia that much resemble the epidermis. The oral stratum corneum contains a lipid mixture similar to that in the epidermal stratum corneum but in lower amounts and is accordingly more permeable. The superficial regions of the nonkeratinized oral epithelia also provide a permeability barrier. These epithelial regions do contain ceramides, cholesterol, and free fatty acids, which may underlie barrier function. The oral epithelial permeability barriers primarily protect the underlying tissue by preventing the penetration of potentially toxic substances, including microbial products. Transdermal drug delivery, buccal absorption, and lipid-related disease are discussed.

A mussel-inspired film for adhesion to wet buccal tissue and efficient buccal drug delivery

Administration of drugs via the buccal route has attracted much attention in recent years. However, developing systems with satisfactory adhesion under wet conditions and adequate drug bioavailability still remains a challenge. Here, we propose a mussel-inspired mucoadhesive film. Ex vivo models show that this film can achieve strong adhesion to wet buccal tissues (up to 38.72 ± 10.94 kPa). We also demonstrate that the adhesion mechanism of this film relies on both physical association and covalent bonding between the film and mucus. Additionally, the film with incorporated polydopamine nanoparticles shows superior advantages for transport across the mucosal barrier, with improved drug bioavailability (~3.5-fold greater than observed with oral delivery) and therapeutic efficacy in oral mucositis models (~6.0-fold improvement in wound closure at day 5 compared with that observed with no treatment). We anticipate that this platform might aid the development of tissue adhesives and inspire the design of nanoparticle-based buccal delivery systems.

Response of human oral mucosal epithelial cells to different storage temperatures: A structural and transcriptional study

PURPOSE

Seeking to improve the access to regenerative medicine, this study investigated the structural and transcriptional effects of storage temperature on human oral mucosal epithelial cells (OMECs).

METHODS

Cells were stored at four different temperatures (4°C, 12°C, 24°C and 37°C) for two weeks. Then, the morphology, cell viability and differential gene expression were examined using light and scanning electron microscopy, trypan blue exclusion test and TaqMan gene expression array cards, respectively.

RESULTS

Cells stored at 4°C had the most similar morphology to non-stored controls with the highest viability rate (58%), whereas the 37°C group was most dissimilar with no living cells. The genes involved in stress-induced growth arrest (GADD45B) and cell proliferation inhibition (TGFB2) were upregulated at 12°C and 24°C. Upregulation was also observed in multifunctional genes responsible for morphology, growth, adhesion and motility such as EFEMP1 (12°C) and EPHA4 (4°C-24°C). Among genes used as differentiation markers, PPARA and TP53 (along with its associated gene CDKN1A) were downregulated in all temperature conditions, whereas KRT1 and KRT10 were either unchanged (4°C) or downregulated (24°C and 12°C; and 24°C, respectively), except for upregulation at 12°C for KRT1.

CONCLUSIONS

Cells stored at 12°C and 24°C were stressed, although the expression levels of some adhesion-, growth- and apoptosis-related genes were favourable. Collectively, this study suggests that 4°C is the optimal storage temperature for maintenance of structure, viability and function of OMECs after two weeks.

Synthetic peptide SVVYGLR upregulates cell motility and facilitates oral mucosal wound healing

Osteopontin-derived SVVYGLR (SV) 7-amino-acid sequence is a multifunctional and synthetic SV peptide implicated in angiogenesis, production of collagen III, and fibroblast differentiation into myofibroblasts. This study investigated the effect of the SV peptide on mucosal wound healing activity. Normal human-derived gingival fibroblasts (NHGF) and human oral mucosa keratinocytes (HOMK) were used for in vitro experiments. In addition, an oral punch wound was prepared at the buccal mucosa in male rats aged 11 weeks, and we evaluated the effect of local injection of SV peptide on wound healing. The synthetic SV peptide showed no influence on the proliferation and adhesion properties of NHGF and HOMK, but it enhanced the cell motility and migration activities. TGF-β1 receptor inhibitor, SB431542 or SB505124, substantially suppressed the SV peptide-induced migration activity, suggesting an involvement of TGF-β1 receptor activation. Furthermore, SV peptide accelerated the healing process of an in vivo oral wound model, compared with control groups. Further immunohistological staining of wound tissue revealed that an increase in capillary growth and the greater number of fibroblasts and myofibroblasts that migrated into the wound area might contribute to the facilitation of the healing process produced by the SV peptide. The SV peptide has beneficial effects on oral wound healing through enhancement of the earlier phase consisting of angiogenesis and remodeling with granulation tissue. The synthetic SV peptide can be a useful treatment option, particularly for intractable mucosal wounds caused by trauma or surgery for progressive lesions such as oral cancer.

HIV-1 proteins gp120 and tat induce the epithelial-mesenchymal transition in oral and genital mucosal epithelial cells

The oral, cervical, and genital mucosa, covered by stratified squamous epithelia with polarized organization and strong tight and adherens junctions, play a critical role in preventing transmission of viral pathogens, including human immunodeficiency virus (HIV). HIV-1 interaction with mucosal epithelial cells may depolarize epithelia and disrupt their tight and adherens junctions; however, the molecular mechanism of HIV-induced epithelial disruption has not been completely understood. We showed that prolonged interaction of cell-free HIV-1 virions, and viral envelope and transactivator proteins gp120 and tat, respectively, with tonsil, cervical, and foreskin epithelial cells induces an epithelial-mesenchymal transition (EMT). EMT is an epigenetic process leading to the disruption of mucosal epithelia and allowing the paracellular spread of viral and other pathogens. Interaction of cell-free virions and gp120 and tat proteins with epithelial cells substantially reduced E-cadherin expression and activated vimentin and N-cadherin expression, which are well-known mesenchymal markers. HIV gp120- and tat-induced EMT was mediated by SMAD2 phosphorylation and activation of transcription factors Slug, Snail, Twist1 and ZEB1. Activation of TGF-β and MAPK signaling by gp120, tat, and cell-free HIV virions revealed the critical roles of these signaling pathways in EMT induction. gp120- and tat-induced EMT cells were highly migratory via collagen-coated membranes, which is one of the main features of mesenchymal cells. Inhibitors of TGF-β1 and MAPK signaling reduced HIV-induced EMT, suggesting that inactivation of these signaling pathways may restore the normal barrier function of mucosal epithelia.

Genotoxicological analyses of insectivorous bats (Mammalia: Chiroptera) in central Brazil: The oral epithelium as an indicator of environmental quality

The micronucleus (MN) test of the human buccal mucosa was developed more than 30 years ago, although this technique has only recently been applied to wild mammals. This paper presents a pioneering study in the genotoxicological evaluation of the exfoliated cells of the buccal mucosa of bats. The assay was applied to two insectivorous bat species (Noctilio albiventris and Pteronotus parnellii) sampled in riparian corridors located in the city of Palmas (capital of the Brazilian state of Tocantins), with the results being compared with those obtained for a third insectivorous species (Nyctinomops laticaudatus), which has established a colony under a road bridge in the same region. This colony represents one of the largest molossidae populations ever recorded in Brazil. A significantly higher frequency of micronuclei was recorded in this colony, as well as a number of other nuclear abnormalities, including binucleated cells, cells with condensed chromatin and karyolysis, in comparison with the bats from the riparian corridors, indicating that the bats from the bridge colony are more susceptible to genotoxic damage. Thus, it is demonstrated the importance of the biomarker (MN) for use in wild animals and allows to conclude that colony bats are more susceptible to genotoxic damages.

Peri-Implant Mucosal Creeping: Two Case Reports

While creeping attachment in natural teeth has been reported in the literature for decades, the same phenomenon around dental implants is a new concept. This article describes two implant cases treated with free gingival autograft with follow-up at 18 and 30 months. Progressive coronal creeping of the mucosal margin was observed covering the implant and abutment surfaces postoperatively. This report demonstrates that mucosal creeping around implants may occur after peri-implant plastic surgical procedures, further improving the final outcomes of therapy.

IL-36 and IL-1/IL-17 Drive Immunity to Oral Candidiasis via Parallel Mechanisms

Protection against microbial infection by the induction of inflammation is a key function of the IL-1 superfamily, including both classical IL-1 and the new IL-36 cytokine families. Candida albicans is a frequent human fungal pathogen causing mucosal infections. Although the initiators and effectors important in protective host responses to C. albicans are well described, the key players in driving these responses remain poorly defined. Recent work has identified a central role played by IL-1 in inducing innate Type-17 immune responses to clear C. albicans infections. Despite this, lack of IL-1 signaling does not result in complete loss of immunity, indicating that there are other factors involved in mediating protection to this fungus. In this study, we identify IL-36 cytokines as a new player in these responses. We show that C. albicans infection of the oral mucosa induces the production of IL-36. As with IL-1α/β, induction of epithelial IL-36 depends on the hypha-associated peptide toxin Candidalysin. Epithelial IL-36 gene expression requires p38-MAPK/c-Fos, NF-κB, and PI3K signaling and is regulated by the MAPK phosphatase MKP1. Oral candidiasis in IL-36R-/- mice shows increased fungal burdens and reduced IL-23 gene expression, indicating a key role played by IL-36 and IL-23 in innate protective responses to this fungus. Strikingly, we observed no impact on gene expression of IL-17 or IL-17-dependent genes, indicating that this protection occurs via an alternative pathway to IL-1-driven immunity. Thus, IL-1 and IL-36 represent parallel epithelial cell-driven protective pathways in immunity to oral C. albicans infection.

THE IMPACT OF THE ACRYLIC MONOMER ON THE MORPHOLOGICAL STRUCTURE OF RAT LINGUAL MUCOSA

The analysis of publications shows that diverse multiple factors can induce changes in taste sensitivity and the main irritants are the chemicals of different types. However, the study of the effect of the components of dental structural materials on the state of lingual mucosa, in particular, taste sensors, has not been fully elucidated to date. The purpose of the paper was the study of the effect of monomer of the "Ftoraks" base acrylic resin on the state of the rats' lingual mucosa within 2-4 weeks after its impact. The previous paper [5] presents the findings of the study on the impact of the monomer of the "Ftoraks" base acrylic resin on the state of the rats' lingual mucosa in the early period (1 to 7 days) and its subsequent regeneration. The studies have found that the greatest changes in the lingual mucosa occur on day 3 and 7 after the application of monomer, and are of erosive-inflammatory origin. Regeneration of the lingual epithelium is delayed. The studies confirm that the monomer of acrylic resin causes a number of pathological changes in the mucous membrane and muscles of the rat tongue, the nature of which varies depending on the duration of its impact. On day 14 in the lingual mucosa the destructive processes are significantly delayed, substituting for the sclerotic processes in the proper plate and atrophic processes, observed, first of all, in the papillae of the tongue. It is appropriate to assume that such changes in the papillae will lead to violation of the taste reception, first of all, in the areas of lateral surfaces of the body of the tongue and in the root area. At the same time, it should be noted that at the end of the experimental period (on day 28 of the contact of the monomer with the lingual mucosa), in the mucous membrane of the tongue, along with atrophic and sclerotic processes, the destructive changes and inflammatory reaction are evident. We hypothesize that this may indicate about partial recovery of taste sensitivity due to the decrease in the number of gustatory buds, taste papillae of different types and the increase in the period of their regeneration.

Evaluation of the miRNA-146a and miRNA-155 Expression Levels in Patients with Oral Lichen Planus

BACKGROUND

Oral Lichen Planus (OLP) is a chronic autoimmune disease that could be considered as a potential premalignant status.

OBJECTIVE

To evaluate the miRNA-146a and miRNA-155 expression levels in patients with oral Lichen planus lesions compared to healthy subjects with normal oral mucosa.

METHODS

Forty patients with oral lichen planus and 18 healthy age and gender-matched controls were recruited in this case-control study. Oral lichen planus was diagnosed clinically and pathologically. The expression levels of two miRNAs in peripheral blood samples were determined using commercial TaqMan MicroRNA Assays. Relative quantification of gene expression was calculated by the 2-ΔΔct method.

RESULTS

The expression levels of miRNA-146a and miRNA-155 in patients with oral Lichen planus were significantly higher than those of healthy controls. Also, a direct but insignificant correlation was found between miRNA-155 and miRNA-146a expression levels among the patient group.

CONCLUSION

Our findings indicate that miRNA-146a and miRNA-155 could be potential biomarkers for the immunopathogenesis of oral lichen planus.

Overexpression of immunomodulatory mediators in oral precancerous lesions

Human leukocyte antigen (HLA) G and E, programmed cell death 1 ligand 1 (PD-L1), IL-10 and TGF-β are proteins involved in failure of the antitumor immune response. We investigated the expression of these immunomodulatory mediators in oral precancerous lesions (oral leukoplakia-OL; n=80) and whether these molecules were related to the risk of malignant transformation. Samples of normal mucosa (n=20) and oral squamous cells carcinoma (OSCC, n=20) were included as controls. Tissue and saliva samples were analyzed by immunohistochemistry and ELISA respectively. Fifteen OL samples showed severe dysplasia (18.7%) and 40 samples (50%) presented combined high Ki-67/p53. Irrespective of the degree of epithelial dysplasia and the proliferation/apoptosis index of OL, the expression of HLA-G, -E, PD-L1, IL-10, TGF-β2 and -β3 was higher to control (P<0.05) and similar to OSCC (P>0.05). The number of granzyme B+ cells in OL was similar to control (P=0.28) and lower compared to OSCC (P<0.01). Salivary concentrations of sHLA-G, IL-10 and TGF-β did not allow for a distinction between OL and healthy individuals. Overexpression of immunosuppressive mediators in the OL reflects the immune evasion potential of this lesion, which is apparently independent of at cytological and proliferation/apoptosis status.

Epithelial barrier and oral bacterial infection

The oral epithelial barrier separates the host from the environment and provides the first line of defense against pathogens, exogenous substances and mechanical stress. It consists of underlying connective tissue and a stratified keratinized epithelium with a basement membrane, whose cells undergo terminal differentiation resulting in the formation of a mechanically resistant surface. Gingival keratinocytes are connected by various transmembrane proteins, such as tight junctions, adherens junctions and gap junctions, each of which has a specialized structure and specific functions. Periodontal pathogens are able to induce inflammatory responses that lead to attachment loss and periodontal destruction. A number of studies have demonstrated that the characteristics of pathogenic oral bacteria influence the expression and structural integrity of different cell-cell junctions. Tissue destruction can be mediated by host cells following stimulation with cytokines and bacterial products. Keratinocytes, the main cell type in gingival epithelial tissues, express a variety of proinflammatory cytokines and chemokines, including interleukin-1alpha, interleukin-1beta, interleukin-6, interleukin-8 and tumor necrosis factor-alpha. Furthermore, the inflammatory mediators that may be secreted by oral keratinocytes are vascular endothelial growth factor, prostaglandin E2 , interleukin-1 receptor antagonist and chemokine (C-C motif) ligand 2. The protein family of matrix metalloproteinases is able to degrade all types of extracellular matrix protein, and can process a number of bioactive molecules. Matrix metalloproteinase activities under inflammatory conditions are mostly deregulated and often increased, and those mainly relevant in periodontal disease are matrix metalloproteinases 1, 2, 3, 8, 9, 13 and 24. Viral infection may also influence the epithelial barrier. Studies show that the expression of HIV proteins in the mucosal epithelium is correlated with the disruption of epithelial tight junctions, suggesting a possible enhancement of human papilloma virus infection by HIV-associated disruption of tight junctions. Altered expression of matrix metalloproteinases was demonstrated in keratinocytes transformed with human papilloma virus-16 or papilloma virus-18,. To summarize, the oral epithelium is able to react to a variety of exogenous, possibly noxious influences.

Molecular aspects of the pathogenesis of periodontitis

The past decade of basic research in periodontology has driven radical changes in our understanding and perceptions of the pathogenic processes that drive periodontal tissue destruction. The core elements of the classical model of disease pathogenesis, developed by Page & Kornman in 1997, remain pertinent today; however, our understanding of the dynamic interactions between the various microbial and host factors has changed significantly. The molecular era has unraveled aspects of genetics, epigenetics, lifestyle and environmental factors that, in combination, influence biofilm composition and the host's inflammatory immune response, creating a heterogenic biological phenotype that we label as 'periodontitis'. In this volume of Periodontology 2000, experts in their respective fields discuss these emerging concepts, such as a health-promoting biofilm being essential for periodontal stability, involving a true symbiosis between resident microbial species and each other and also with the host response to that biofilm. Rather like the gut microbiome, changes in the local environment, which may include inflammatory response mediators or viruses, conspire to drive dysbiosis and create a biofilm that supports pathogenic species capable of propagating disease. The host response is now recognized as the major contributor to periodontal tissue damage in what becomes a dysfunctional, poorly targeted and nonresolving inflammation that only serves to nourish and sustain the dysbiosis. The role of epithelial cells in signaling to the immune system is becoming clearer, as is the role of dendritic cells as transporters of periodontal pathogens to distant sites within the body, namely metastatic infection. The involvement of nontraditional immune cells, such as natural killer cells, is being recognized, and the simple balance between T-helper 1- and T-helper 2-type T-cell populations has become less clear with the emergence of T-regulatory cells, T-helper 17 cells and follicular helper cells. The dominance of the neutrophil has emerged, not only as a potential destructor when poorly regulated but as an equally unpredictable effector cell for specific B-cell immunity. The latter has emerged, in part, from the realization that neutrophils live for 5.4 days in the circulation, rather than for 24 h, and are also schizophrenic in nature, being powerful synthesizers of proinflammatory cytokines but also responding to prostaglandin signals to trigger a switch to a pro-resolving phenotype that appears capable of regenerating the structure and function of healthy tissue. Key to these outcomes are the molecular signaling pathways that dominate at any one time, but even these are influenced by microRNAs capable of 'silencing' certain inflammatory genes. This volume of Periodontology 2000 tries to draw these complex new learnings into a contemporary model of disease pathogenesis, in which inflammation and dysbiosis impact upon whether the outcome is driven toward acute resolution and stability, chronic resolution and repair, or failed resolution and ongoing periodontal tissue destruction.

The Principles of Functional and Mucostatic Impressions for Complete Denture Bases: A Review

In addition to needing to be hygienic and biocompatible, the base of a complete denture (CD) should provide intimate adaptation to the mucosa of a ridge. The ridge form may differ under function than when at rest because of the compressibility of mucosa. This viscoelastic behavior of ridge mucosa has been a focus of research and a clinical challenge confronted by dentists when making impressions. This article discusses the basic principles of nonpressure mucostatic and selective-pressure functional impression concepts and provides a theoretical and scientific basis for the design of a CD base.

Matrix Metalloproteinase-3 Differences in Oral and Skin Fibroblasts

While skin wounds heal by scarring, wounds of oral mucosa show privileged healing with minimal scar formation. Our hypothesis was that phenotypic differences between oral and skin fibroblasts underlie these differences in healing. The aims of this study were to compare MMP-3 expression by oral and skin fibroblasts and investigate a role for MMP-3 in mediating collagen gel contraction. Oral fibroblasts induced significantly greater gel contraction than did paired skin cells. Inhibition of MMP activity significantly inhibited gel contraction by both cell types. Specific inhibition of MMP-3 activity reduced gel contraction by oral, but not skin, fibroblasts. Oral fibroblasts produced significantly higher levels of MMP-3 than did skin fibroblasts at all levels studied. TGF-β1 and -β3 isoforms stimulated MMP-3 expression at mRNA, protein, and activity levels by both fibroblast populations. Results suggest that increased MMP-3 production by oral fibroblasts may underlie the differences in wound-healing outcome seen in skin and oral mucosa.

Development of three-dimensional tissue engineered bone-oral mucosal composite models

Tissue engineering of bone and oral mucosa have been extensively studied independently. The aim of this study was to develop and investigate a novel combination of bone and oral mucosa in a single 3D in vitro composite tissue mimicking the natural structure of alveolar bone with an overlying oral mucosa. Rat osteosarcoma (ROS) cells were seeded into a hydroxyapatite/tri-calcium phosphate scaffold and bone constructs were cultured in a spinner bioreactor for 3 months. An engineered oral mucosa was fabricated by air/liquid interface culture of immortalized OKF6/TERET-2 oral keratinocytes on collagen gel-embedded fibroblasts. EOM was incorporated into the engineered bone using a tissue adhesive and further cultured prior to qualitative and quantitative assessments. Presto Blue assay revealed that ROS cells remained vital throughout the experiment. The histological and scanning electron microscope examinations showed that the cells proliferated and densely populated the scaffold construct. Micro computed tomography (micro-CT) scanning revealed an increase in closed porosity and a decrease in open and total porosity at the end of the culture period. Histological examination of bone-oral mucosa model showed a relatively differentiated parakeratinized epithelium, evenly distributed fibroblasts in the connective tissue layer and widely spread ROS cells within the bone scaffold. The feasibility of fabricating a novel bone-oral mucosa model using cell lines is demonstrated. Generating human 'normal' cell-based models with further characterization is required to optimize the model for in vitro and in vivo applications.

Oral epithelial cells and their interactions with HIV-1

As the AIDS pandemic has continued, our understanding of the events that occur during the entry and infection of conventional, susceptible cells has increased dramatically, leading to the development of control therapies for HIV-infected individuals. However, an ongoing hole in our understanding is how HIV crosses the mucosal barriers to gain access to permissive cells, despite how important this information would be in developing successful vaccines and other preventative measures such as topical anti-HIV microbicides. In particular, our knowledge of the role that epithelial cells of the mucosal surfaces play in infection - both during early phases and throughout the life of an infected individual, is currently hazy at best. However, several studies in recent years suggest that HIV can bind to and traverse these mucosal epithelial cells, providing a reservoir of infection that can subsequently infect underlying permissive cells. Despite this interaction with epithelial cells, evidence suggests HIV-1 does not productively infect these cells, although they are capable of transferring surface-bound and transcytosed virus to other, permissive cells. Further, there appear to be key differences between adult and infant epithelial cells in the degree to which HIV can transcytose and infect the epithelium. Thus, it is clear that, whilst not primary targets for infection and virus replication, epithelial cells play an important role in the infection cycle and improving our understanding of their interactions with HIV could potentially provide key insights necessary to develop effective preventative therapies.

Ex vivo and in vivo modulatory effects of umbilical cord Wharton's jelly stem cells on human oral mucosa stroma substitutes

Novel oral mucosa substitutes have been developed in the laboratory using human umbilical cord Wharton's jelly stem cells -HWJSC- as an alternative cell source. In the present work, we have generated human oral mucosa substitutes with oral mucosa keratinocytes and HWJSC to determine the influence of these cell sources on stromal differentiation. First, acellular and cellular stroma substitutes and bilayered oral mucosa substitutes with an epithelial layer consisting of oral mucosa keratinocytes -OM samples- or HWJSC -hOM- were generated. Then, tissues were analyzed by light and electron microscopy, histochemistry and immunohistochemistry to quantify all major extracellular matrix components after 1, 2 and 3 weeks of ex vivo development, and OM and hOM were also analyzed after in vivo grafting. The results showed that bioengineered oral mucosa stromas displayed an adequate fibrillar mesh. Synthesis of abundant collagen fibers was detected in OM and hOM after 3 weeks, and in vivo grafting resulted in an increased collagen synthesis. No elastic or reticular fibers were found. Glycoprotein synthesis was found at the epithelial-stromal layer when samples were grafted in vivo. Finally, proteoglycans, decorin, versican and aggrecan were strongly dependent on the in vivo environment and the presence of a well-structured epithelium on top. The use of HWJSC was associated to an increased synthesis of versican. These results confirm the usefulness of fibrin-agarose biomaterials for the generation of an efficient human oral mucosa stroma substitute and the importance of the in vivo environment and the epithelial-mesenchymal interaction for the adequate differentiation of the bioengineered stroma.

Spectroscopic microscopy can quantify the statistics of subdiffractional refractive-index fluctuations in media with random rough surfaces

We previously established that spectroscopic microscopy can quantify subdiffraction-scale refractive index (RI) fluctuations in a label-free dielectric medium with a smooth surface. However, to study more realistic samples, such as biological cells, the effect of rough surface should be considered. In this Letter, we first report an analytical theory to synthesize microscopic images of a rough surface, validate this theory by finite-difference time-domain (FDTD) solutions of Maxwell's equations, and characterize the spectral properties of light reflected from a rough surface. Then, we report a technique to quantify the RI fluctuations beneath a rough surface and demonstrate its efficacy on FDTD-synthesized spectroscopic microscopy images, as well as experimental data obtained from biological cells.

Tracing CD34+ Stromal Fibroblasts in Palatal Mucosa and Periodontal Granulation Tissue as a Possible Cell Reservoir for Periodontal Regeneration

The aim of the present research was to trace CD34+ stromal fibroblastic cells (CD34+ SFCs) in the palatal connective tissue harvested for muco-gingival surgical procedures and in granulation tissues from periodontal pockets using immunohistochemical and transmission electron microscopy. Immunohistochemical analysis targeted the presence of three antigens: CD31, α-smooth muscle actin (α-SMA), and CD34. In the palate, CD31 staining revealed a colored inner ring of the vessels representing the endothelium, α-SMA+ was located in the medial layer of the vasculature, and CD34 was intensely expressed by endothelial cells and artery adventitial cells (considered to be CD34+ SFCs). Granulation tissue showed the same pattern for CD31+ and α-SMA, but a different staining pattern for CD34. Ultrastructural examination of the palatal tissue highlighted perivascular cells with fibroblast-like characteristics and pericytes in close spatial relationship to endothelial cells. The ultrastructural evaluation of granulation tissue sections confirmed the presence of neovasculature and the inflammatory nature of this tissue. The present study traced the presence of CD34+ SFCs and of pericytes in the palatal connective tissue thus highlighting once more its intrinsic regenerative capabilities. The clinical and systemic factors triggering mobilization and influencing the fate of local CD34+SCFs and other progenitors are issues to be further investigated.

Oral Mucosal Lesions: Oral Cavity Biology-Part I

It is important to evaluate the background of oral cavity biology to define morphologic abrasions in oral mucosa following a host of local and/ or systemic disorders. The oral cavity is not only the beginning of the digestive system, but it also plays a significant role in communication; the voice (although the voice is produced in the throat), tongue, lips, and jaw are its essential components to produce the range of sounds. The vestibule and the oral cavity are its major parts, and are usually moist. The lips and the teeth are in approximation, marking its start up. The anatomy of the oral cavity in brief has been reviewed in right prospective for disease related changed morphology, thus facilitating interpretation.

Human oral mucosa tissue-engineered constructs monitored by Raman fiber-optic probe

In maxillofacial and oral surgery, there is a need for the development of tissue-engineered constructs. They are used for reconstructions due to trauma, dental implants, congenital defects, or oral cancer. A noninvasive monitoring of the fabrication of tissue-engineered constructs at the production and implantation stages done in real time is extremely important for predicting the success of tissue-engineered grafts. We demonstrated a Raman spectroscopic probe system, its design and application, for real-time ex vivo produced oral mucosa equivalent (EVPOME) constructs noninvasive monitoring. We performed in vivo studies to find Raman spectroscopic indicators for postimplanted EVPOME failure and determined that Raman spectra of EVPOMEs preexposed to thermal stress during manufacturing procedures displayed correlation of the band height ratio of CH2 deformation to phenylalanine ring breathing modes, giving a Raman metric to distinguish between healthy and compromised postimplanted constructs. This study is the step toward our ultimate goal to develop a stand-alone system, to be used in a clinical setting, where the data collection and analysis are conducted on the basis of these spectroscopic indicators with minimal user intervention.

Buccal cortical bone thickness at miniscrew placement sites in patients with different vertical skeletal patterns

OBJECTIVE

Cortical bone thickness plays an important role in the primary stability of miniscrews. The purpose of this study was to evaluate the buccal cortical bone thickness in adolescent subjects with different vertical skeletal patterns using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

We examined the CBCT images of 75 patients (30 males, 45 females; mean age 16.5 years; range 15.3-17.7 years) in the present study. High-, average- and low-angle subgroups were generated according to SN-GoMe angle. On volumetric images, we measured the buccal cortical bone thickness from canine to the second molar teeth at heights of 5, 7 and 9 mm from cemento-enamel junction (CEJ). For statistical evaluation, the Wilcoxon signed rank, Kruskal-Wallis and Tukey HSD tests were applied at the p < 0.05 level.

RESULTS

Buccal cortical bone was thickest in the low-angle group. We observed statistically significant differences in the maxilla between the high- and low-angle groups at all levels. In the mandible, we noted statistically significant differences between high-angle and low-angle groups in the canine-first premolar regions at heights of 5 and 7 mm, and in the second premolar-first molar region at 7 mm height from CEJ. Significant differences were also present between the first and second premolars at heights of 7 and 9 mm. Average cortical bone thickness ranged from 1.10-1.37 mm in the maxilla and 1.20-3.28 mm in the mandible for all groups.

CONCLUSION

Buccal cortical bone thickness in adolescents varied in different vertical skeletal patterns and was greater in the mandible than in the maxilla, with the distance increasing from the CEJ to the apex. As the buccal cortical bone is thinner in high-angle patients, patient-specific measures should be taken when performing miniscrew treatment.

Leptin promotes wound healing in the oral mucosa

INTRODUCTION

Leptin, a 16 kDa circulating anti-obesity hormone, exhibits many physiological properties. Recently, leptin was isolated from saliva; however, its function in the oral cavity is still unclear. In this study, we investigated the physiological role of leptin in the oral cavity by focusing on its effect on wound healing in the oral mucosa.

METHODS

Immunohistochemical analysis was used to examine the expression of the leptin receptor (Ob-R) in human/rabbit oral mucosa. To investigate the effect of leptin on wound healing in the oral mucosa, chemical wounds were created in rabbit oral mucosa, and leptin was topically administered to the wound. The process of wound repair was histologically observed and quantitatively analyzed by measuring the area of ulceration and the duration required for complete healing. The effect of leptin on the proliferation, differentiation and migration of human oral mucosal epithelial cells (RT7 cells) was investigated using crystal violet staining, reverse transcription polymerase chain reaction (RT-PCR) and a wound healing assay, respectively.

RESULTS

Ob-R was expressed in spinous/granular cells in the epithelial tissue and vascular endothelial cells in the subepithelial connective tissue of the oral mucosa. Topical administration of leptin significantly promoted wound healing and shortened the duration required for complete healing. Histological analysis of gingival tissue beneath the ulceration showed a denser distribution of blood vessels in the leptin-treated group. Although the proliferation and differentiation of RT7 cells were not affected by leptin, the migration of these cells was accelerated in the presence of leptin.

CONCLUSION

Topically administered leptin was shown to promote wound healing in the oral mucosa by accelerating epithelial cell migration and enhancing angiogenesis around the wounded area. These results strongly suggest that topical administration of leptin may be useful as a treatment to promote wound healing in the oral mucosa.

In vitro evaluation of three electronic apex locators using conventional methods and cone beam computed tomography

AIM

The aim of this paper was to evaluate the measurement accuracy of three electronic apex locators by digital radiography, stereomicroscope and cone beam computed tomography (CBCT).

METHODS

This in vitro experimental analytic-descriptive study included 90 extracted permanent teeth with mature apices from the inter-canine region, divided into three groups. In vitro electronic root canal measurement was utilized using three different apex locators: ProPex Dentsply, Apex NRG Blue and Romi Apex 15A. After digital radiographic imaging and measurements Cone Beam Computer Tomography (CBCT) imaging with voxel edge size 0.125 mm was utilized and finally the apical portion of the root is grounded (5 mm) along its axis to prepare it for stereomicroscopic measurements.

RESULTS

The performed test of significance shows that there is no difference between the apex locators and the control length as measured by computed digital radiography (CDR), P-values of the t-tests are all >0.05. The t-tests showed that there is no significant differences between the measurements conducted by stereomicroscope and the measurements results obtained using CBCT; measurements performed by the three apex locators (Propex, NRG-Blue, and Rami Apex), were accurate within 0.5 mm 87%, 93%, and 87% of the time, respectively. The statistical analysis showed no significant differences between the three tested apex locators (P>0.05).

CONCLUSION

Based on the conditions of the present study, it can be concluded that all three apex locators (ProPex Dentsply, Apex NRG Blu and Romi Apex 15A) have demonstrated accurate and dependable measurements performed in vitro conditions.

Nanoparticles strengthen intracellular tension and retard cellular migration

Nanoparticles can have profound effects on cell biology. Here, we show that after TiO2, SiO2, and hydroxyapatite nanoparticles treatment, TR146 epithelial cell sheet displayed slower migration. Cells after exposure to the nanoparticles showed increased cell contractility with significantly impaired wound healing capability however without any apparent cytotoxicity. We showed the mechanism is through nanoparticle-mediated massive disruption of the intracellular microtubule assembly, thereby triggering a positive feedback that promoted stronger substrate adhesions thus leading to limited cell motility.

Wharton's jelly stem cells: a novel cell source for oral mucosa and skin epithelia regeneration

Perinatal stem cells such as human umbilical cord Wharton's jelly stem cells (HWJSCs) are excellent candidates for tissue engineering because of their proliferation and differentiation capabilities. However, their differentiation potential into epithelial cells at in vitro and in vivo levels has not yet been reported. In this work we have studied the capability of HWJSCs to differentiate in vitro and in vivo to oral mucosa and skin epithelial cells using a bioactive three-dimensional model that mimics the native epithelial-mesenchymal interaction. To achieve this, primary cell cultures of HWJSCs, oral mucosa, and skin fibroblasts were obtained in order to generate a three-dimensional heterotypical model of artificial oral mucosa and skin based on fibrin-agarose biomaterials. Our results showed that the cells were unable to fully differentiate to epithelial cells in vitro. Nevertheless, in vivo grafting of the bioactive three-dimensional models demonstrated that HWJSCs were able to stratify and to express typical markers of epithelial differentiation, such as cytokeratins 1, 4, 8, and 13, plakoglobin, filaggrin, and involucrin, showing specific surface patterns. Electron microscopy analysis confirmed the presence of epithelial cell-like layers and well-formed cell-cell junctions. These results suggest that HWJSCs have the potential to differentiate to oral mucosa and skin epithelial cells in vivo and could be an appropriate novel cell source for the development of human oral mucosa and skin in tissue engineering protocols.

Characterizing morphology and nonlinear elastic properties of normal and thermally stressed engineered oral mucosal tissues using scanning acoustic microscopy

This study examines the use of high-resolution ultrasound to monitor changes in the morphology and nonlinear elastic properties of engineered oral mucosal tissues under normal and thermally stressed culture conditions. Nonlinear elastic properties were determined by first developing strain maps from acoustic ultrasound, followed by fitting of nonlinear stress-strain data to a 1-term Ogden model. Testing examined a clinically developed ex vivo produced oral mucosa equivalent (EVPOME). As seeded cells proliferate on an EVPOME surface, they produce a keratinized protective upper layer that fills in and smoothens out surface irregularities. These transformations can also alter the nonlinear stress/strain parameters as EVPOME cells differentiate. This EVPOME behavior is similar to those of natural oral mucosal tissues and in contrast to an unseeded scaffold. If ultrasonic monitoring could be developed, then tissue cultivation could be adjusted in-process to account for biological variations in their development of the stratified cellular layer. In addition to ultrasonic testing, an in-house-built compression system capable of accurate measurements on small (∼1.0-1.5 cm(2)) tissue samples is presented. Results showed a near 2.5-fold difference in the stiffness properties between the unstressed EVPOME and the noncell-seeded acellular scaffold (AlloDerm(®)). There were also 4×greater differences in root mean square values of the thickness in the unseeded AlloDerm compared to the mature unstressed EVPOME; this is a strong indicator for quantifying surface roughness.

[Buccal epithelium as an object for testing of biological age and the speed of aging]

Testing of biological age and the speed of aging is one of the main goal of gerontology and predictive medicine. This review summarizes the ability of using buccal epithelium as target of non-invasive investigation of aging diagnostics. Buccal epithelium used for thelomere test and morphological characteristics of its nucleus demonstrate the speed of aging. The electrophysiological investigation of buccal cells nucleus are the markers of biological age of a human. In future it can be possible to use buccal epithelium for immunogistochemical investigation with goal to diagnose cellular senescence.

Saliva and wound healing

Wounds in the oral cavity heal faster and with less scarring than wounds in other parts of the body. One of the factors implicated in this phenomenon is the presence of saliva, which promotes the healing of oral wounds in several ways. Saliva creates a humid environment, which improves the survival and functioning of inflammatory cells that are crucial for wound healing. Furthermore, saliva contains a variety of proteins that play a role in the various stages of the intraoral wound healing. Tissue factor, present in salivary exosomes, accelerates the clotting of blood dramatically. The subsequent proliferation of epithelial cells is promoted by growth factors in saliva, especially epidermal growth factor. The importance of secretory leucocyte protease inhibitor is demonstrated by the observation that in the absence of this salivary protein, oral wound healing is considerably delayed. Members of the salivary histatin family promote wound closure in vitro by enhancing cell spreading and cell migration. Cell proliferation is not enhanced by histatin. Cyclization of histatin increased its biological activity approximately 1,000-fold compared to linear histatin. These studies suggest that histatins could potentially be used for the development of new wound healing medications.

[Specific features of thermotophographical maps of oral muscosa]

The article presents the results of infrared thermography in 256 healthy people (123 women and 133 men) aged 36 to 60 years. Thermometric and thermography values in 72 selected points of the oral mucosa were assessed in all study participants. As a result normal thermometric and thermal values of oral mucosa were identified thus completing thermal maps of middle aged men and women.

Adaptive changes of the electrophoretic mobility of cell nuclei (EMN) index in the intensive physical exercise of male rowers with different training experience

The aim of this study is to attempt to determine the relationship between the degree of the EMN index and the depth of changes of selected hormones and metabolic parameters as an effect of intensive physical exercise during the training process in male rowers. Juniors (N = 62; chronological age 16.4 y.o. SD = 1.14 y.; training experience 3.0 y.o. SD = 1.05 y.) and seniors (N = 27; chronological age 21.4 y. SD = 1.73 y.; training experience 5.5 y.o. SD = 1.10 y.), in the preparatory period of the training process, performed physical exercise of maximum intensity on a rowing ergometer. Acid-base balance parameters (pH, BE) and the concentration of lactic acid (LA) were determined as the result of physical exercise. Some selected hormones were also indicated (hGH, PrL and Prg) to show their exercise changes. A sample of buccal epithelium cells was taken from each of the male rowers, before and after the exercise, to evaluate the percentage of the EMN index by intracellular microelectrophoresis. A greater differentiation of metabolic changes during exercise was manifested in juniors than seniors. This was reflected in changes of acid-base balance parameters, exercise physiological parameters, hormone concentration and also in changes of the EMN index. These changes were probably dependent on deep metabolic processes of an acid character during exercise. This could prove a more stable homeostasis through more economical metabolic reactions in seniors as the effect of the training process, meaning that seniors were better adapted to heavy physical exercise than juniors.

The Chinese soft-shelled turtle, Pelodiscus sinensis, excretes urea mainly through the mouth instead of the kidney

The Chinese soft-shelled turtle, Pelodiscus sinensis, is well adapted to aquatic environments, including brackish swamps and marshes. It is ureotelic, and occasionally submerges its head into puddles of water during emersion, presumably for buccopharyngeal respiration. This study was undertaken to test the hypothesis that the buccophyaryngeal cavity constitutes an important excretory route for urea in P. sinensis. Results indicate that a major portion of urea was excreted through the mouth instead of the kidney during immersion. When restrained on land, P. sinensis occasionally submerged their head into water (20-100 min), during which urea excretion and oxygen extraction occurred simultaneously. These results indicate for the first time that buccopharyngeal villiform processes (BVP) and rhythmic pharyngeal movements were involved in urea excretion in P. sinensis. Urea excretion through the mouth was sensitive to phloretin inhibition, indicating the involvement of urea transporters (UTs). In addition, saliva samples collected from the buccopharyngeal surfaces of P. sinensis injected intraperitoneally with saline contained ~36 mmol N l(-1) urea, significantly higher than that (~2.4 mmol N l(-1)) in the plasma. After intraperitoneal injection with 20 μmol urea g(-1) turtle, the concentration of urea in the saliva collected from the BVP increased to an extraordinarily high level of ~614 μmol N ml(-1), but the urea concentration (~45 μmol N ml(-1)) in the plasma was much lower, indicating that the buccopharyngeal epithelium of P. sinensis was capable of active urea transport. Subsequently, we obtained from the buccopharyngeal epithelium of P. sinensis the full cDNA sequence of a putative UT, whose deduced amino acid sequence had ~70% similarity with human and mouse UT-A2. This UT was not expressed in the kidney, corroborating the proposition that the kidney had only a minor role in urea excretion in P. sinensis. As UT-A2 is known to be a facilitative urea transporter, it is logical to deduce that it was localized in the basolateral membrane of the buccopharyngeal epithelium, and that another type of primary or secondary active urea transporter yet to be identified was present in the apical membrane. The ability to excrete urea through the mouth instead of the kidney might have facilitated the ability of P. sinensis and other soft-shelled turtles to successfully invade the brackish and/or marine environment.

Assessment of nutritional status of clinical patients by determining normal range of oral mucosal apoptosis and proliferation rate

The normal range of oral mucosal cell apoptosis and proliferation rate through a larger sample of non-malnourished crowd was investigated, and the nutritional status of clinical patients was assessed. Of 194 clinical patients selected according to "NRS2002" guidance, there were 167 non-malnourished patients and 27 malnourished cases, respectively. Twelve patients with toxic reactions of grade III after postoperative chemotherapy (POC) were chosen. The oral mucosal epithelial apoptosis and proliferation rate were measured by using flow cytometry. The statistical significance was processed by using unpaired t-test. The results showed that there was no significant difference in gender, age and body weight between malnourished and non-malnourished groups. The normal range of oral mucosal epithelial apoptosis and the proliferation rate was (27.50±1.50)% and (15.12±1.68)% in non-malnourished patients, and that was (19.90±4.14)% and (6.66±5.83)% in the malnourished patients, respectively. It is concluded that the normal range of oral mucosa cell apoptosis and proliferation rate is achieved, which can not be influenced by gender, age, weight and other factors, and could be used as a sensitive and accurate index to assess the nutritional status of clinical patients.

Application of acellular dermal matrix in reconstruction of oral mucosal defects in 36 cases

PURPOSE

Artificial grafts have been investigated for use in the repair of oral mucosal defects. The aim of this retrospective study was to present the outcomes of the use of acellular dermal matrix (ADM) grafts to repair oral mucosal defects.

MATERIALS AND METHODS

Data from 36 patients with oral mucosal defects reconstructed with ADM grafts from 2003 through 2009 were reviewed. All patients were followed-up for at least 6 months to observe the graft repair, wound-healing time, contracture, color, infection, pain, immunologic reaction, texture of the graft, and clinical course. Graft success was defined as the ADM graft being replaced by new mucosa-like tissue and the oral mucosal defect being covered with the new mucosa-like tissue. Any evidence of incomplete graft re-epithelialization or graft sloughing was considered a graft failure (complete or incomplete).

RESULTS

Of the 36 cases, 34 grafts (94.4%) were successfully replaced with new mucosa-like tissues and only 2 grafts (5.6%) failed. No complaints such as pain, immunologic reaction, or infection were observed during the follow-up. Mild graft contraction occurred in 7 patients with lip or buccal defects, especially at approximately 3 to 5 weeks after the reconstructive surgery.

CONCLUSIONS

The ADM grafts for oral mucosal defects were safe and effective. The present data support the clinical application of ADM grafts in reconstructing oral mucosal defects caused by various oral diseases.

Persistent lung oscillator response to CO2 after buccal oscillator inhibition in the adult frog

The automatic ventilatory drive in amphibians depends on two oscillators interacting with each other, the gill/buccal and lung oscillators. The lung oscillator would be homologous to the mammalian pre-Bötzinger complex and the gill/buccal oscillator homologous to the mammalian parafacial respiratory group/retrotrapezoid nucleus (pFRG/RTN). Dysfunction of the pFRG/RTN has been involved in the development of respiratory diseases associated to the loss of CO(2) chemosensitivity such as the congenital central hypoventilation syndrome. Here, on adult in vitro isolated frog brainstem, consequences of the buccal oscillator inhibition (by reducing Cl(-)) were evaluated on the respiratory rhythm developed by the lung oscillator under hypercapnic challenges. Our results show that under low Cl(-) concentration (i) the buccal oscillator is strongly inhibited and the lung burst frequency and amplitude decreased and (ii) it persists a powerful CO(2) chemosensitivity. In conclusion, in frog, the CO(2) chemosensitivity depends on cellular contingent(s) whose the functioning is independent of the concentration of Cl(-) and origin remains unknown.

Cytogenetic abnormalities in exfoliated oral mucosal cells and their association with oral cancer

OBJECTIVE

To assess cytogenetic abnormalities through quantification of micronuclei, broken eggs, and karyorrhexis, in cells from normal oral mucosa of individuals exposed to carcinogens (alcohol and tobacco) and adjacent to leukoplakias and squamous cell carcinomas.

STUDY DESIGN

The sample was composed of 40 subjects aged > 30 years, divided into four groups: control, alcohol/tobacco, leukoplakia, and squamous cell carcinoma. For control and alcohol/tobacco groups, cells were collected from lower lip, tongue border, and floor of the mouth. For leukoplakia and squamous cell carcinoma groups, mucosa contralateral and adjacent to the lesions were analyzed. Cytologic smears were stained with the Feulgen reaction. A blind observer analyzed 1,000 cells per slide to quantify micronuclei, broken eggs, and karyorrhexis.

RESULTS

The leukoplakia group showed an increased number of micronuclei compared to controls (p = 0.0016) and the alcohol/tobacco group (p = 0.0048) and also increased broken eggs compared to the alcohol/tobacco group (p = 0.0172). Similarly, the carcinoma group presented more micronuclei compared to controls (p = 0.0462) and more broken eggs compared to the alcohol/tobacco group (p = 0.0104).

CONCLUSION

The assessment of cytogenetic abnormalities micronuclei and broken eggs may be useful for monitoring individuals exposed to risk factors for developing oral cancer.

Effect of genetic polymorphism of GSTM1 and GSTT1 genotypes on cytogenetic biomarkers among coaltar workers

Chromosomal aberrations (CAs) in peripheral blood lymphocytes and micronuclei (MN) in exfoliated buccal cells have been used for decades as cytogenetic biomarkers to investigate genotoxicity among occupationally or environmentally exposed population. In our study, we investigated the association of increased cytogenetic damage with genetic polymorphism in glutathione-S transferase genotypes among occupationally exposed 115 coaltar workers and 105 unexposed controls. We found higher mean value of chromosome aberrations (chromatid type-2.01±1.76; chromosomal type-2.22±1.73) and buccal micronuclei (BMN-7.10±1.56) in exposed subjects when compared to referents (chromatid type-0.82±.51; chromosomal type-0.87±.54; BMN-5.09±2.88). We observed that individuals having null genotype of GSTM1 and GSTT1 have significantly higher frequency of CAs and MN. Despite of small sample size, our findings suggest a significant association between polymorphism of glutathione-S transferase genotypes and cytogenetic biomarkers which are considered as early effects of genotoxic carcinogens.

Histomorphometric and whole-genome expression analysis of peri-implant soft tissue healing: a comparison of flapless and open surgery

PURPOSE

The structure of peri-implant soft tissue that is regenerated after flapless and flap surgery has been shown to differ. However, its underlying mechanisms are relatively unknown. The present study sought to identify differences in the inflammatory cell infiltration and expression of gene transcripts during transmucosal healing between the two approaches with two different implant designs.

MATERIALS AND METHODS

All mandibular premolars were removed from 12 minipigs. One month later, four implants (two NobelReplace Tapered Groovy and two NobelPerfect Groovy, Nobel Biocare) were placed in each quadrant. One quadrant was randomized to flapless insertion, while the other was chosen for flap surgery in each animal. Following 1, 2, 4, and 12 weeks of transmucosal implant healing, biopsy specimens were retrieved from the peri-implant soft tissue according to a standardized procedure to avoid crossover effects. Samples were subjected to a leukocyte count and a gene expression analysis.

RESULTS

When the flapless placement technique was used, leukocyte influx in the peri-implant soft tissue was significantly smaller compared to open surgery for both implant designs. Gene expression analysis revealed significant overexpression of molecules associated with detoxification and reepithelialization in the flapless group. In contrast, myofibroblast-associated gene transcripts were significantly enriched in the flap surgery group.

CONCLUSIONS

The present data indicate perpetuation of inflammatory reactions as well as increased fibrotic scar tissue deposition in the peri-implant area following implant placement by the flap approach. Flapless implant insertion results in less inflammation and early reepithelialization, providing the potential for the formation of a fully functioning as well as esthetically preferable peri-implant soft tissue collar.

In vivo evaluation of labial microcirculation in diabetics: a comparison with healthy subjects

AIM

Diabetes mellitus, a systemic chronic disease considered an epidemic by the World Health Organization (WHO) due to the rate of increase in the prevalence of diabetes, is a cause of microvascular and macrovascular complications leading to a significant burden for the individual and society. The aim of this study was to evaluate in vivo the effects of type II diabetes mellitus on the microcirculation of oral mucosa.

METHODS

Forty-six subjects, 23 patients with type II diabetes mellitus (10 men, 13 women) and 23 healthy patients (9 men, 14 women) were examined in our laboratory. Oral microcirculation was evaluated on labial mucosa using oral video-capillaroscopy: a diagnostic method that permits the in vivo analysis of oral microcirculation.

RESULTS

Capillary density, total loop length and total diameter resulted significantly altered in diabetics. The density of loops, observed on labial mucosa, is on average lower in diabetics than in healthy patients. The length and total diameter of loops are increased in diabetics.

CONCLUSION

This study shows the capillary alterations that occur in the oral mucosa of diabetics. The loop density decrease is probably a symptom of peripheral microangiopathy. Ultimately, this study demonstrates that there is peripheral damage to microcirculation at the level of the labial mucosa in diabetic subjects and that these alterations are instrumentally "objectivable" and "quantifiable" through the videocapillaroscope technique.

Scanning electron microscopic study of the tongue in the rainbow lorikeet (Trichoglossus haematodus)

The dorsal lingual surfaces of rainbow lorikeet (Trichoglossus haematodus) were examined by scanning electron microscopy. Macroscopically, the tongue of the rainbow lorikeet has a finger-like shape. Three parts are distinguished in the dorsal surface of the tongue: the apex, body, and root of the tongue. The apex of the tongue has numerous processes inclined toward medial side from lateral side. These processes are rod-like structure and smooth surfaces. Many grooves are observed in both lateral sides of the lingual body. A large opening of the lingual gland exists in central part of the lingual root and some large openings of the lingual glands exist in both lateral sides of the lingual root.

[Injury and reparative regeneration of the oral mucosal epithelium after cytostatic drugs administration (tissue, cell and molecular mechanisms)]

This paper presents the systematized summary of current literature data and the authors' own findings on the regularities of human and animal surface oral mucosal epithelium (OME) injury caused by cytostatic drugs (CSD) administration, and on the ways of its regeneration after the cytostatic chemotherapy (CSCT) discontinuation. Tissue, cell and molecular mechanisms of CSCT effects on OME, are described. The direct effects of CSD included the epithelial layer attenuation with the derangement of its architecture, epitheliocyte proliferation suppression, apoptosis activation, and differentiation disturbances (involving the broad spectrum of cytological, cytochemical, ultrastructural and molecular-biological changes). In severe cases, these processes resulted in the loss of the epithelial layer integrity with the development of ulceration. Complete epithelial regeneration requires a long period after the CSCT discontinuation. Indirect effects of CSD on OME are associated with the microbial invasion and the diffusion of microbial vital activity products into the epithelium with concurrent leukopenia, immunosuppression and decreased salivary secretion.

[Provisional implants for immediate overdenture fixation after multiple tooth extraction]

The aim of the study was to assess the effectiveness of immediate overdenture supported by provisional mini-implants after multiple tooth extraction. The study included 39 patients aged 55±17, followed up for 12 months. The first group included 14 patients with 65 mini-implants and 17 soft-lined immediate overdentures. In the second group (10 patients, 45 mini-implants) 12 immediate overdentures had hard liner. In the third group (15 patients) immediate overdentures with hard liner were used without implant support. 12-month implant survival was 98.5% in the I and 91.1% in the II group (1 and 4 implants failed correspondently). The number of denture basis corrections was minimal in the second group (2.9±0.46) and largest in the third group (4.32±0.67). Mini-implants provided better fixation of complete denture, facilitated mucosal adaptation to denture compared with immediate dentures without implant support.

Miniaturized osmotic pump for oromucosal drug delivery with external readout station

We report on a miniaturized, exchangeable drug delivery cartridge for Parkinson's Disease which is integrated in a partial removable prosthesis. An osmotic pumping principle uses saliva to release constantly a separately stored drug to the buccal mucosa, thus avoiding first pass metabolism and drug plasma level fluctuations. Therapeutic relevant information and fill level of the cartridge can be determined before and after usage with an external readout station. The selected material combinations of the cartridge fulfill both, functional and regulatory aspects as well as requirements for assembly and packaging, e.g. thermal fusion bonding, solvent bonding and capillary stop bonding. By using the cartridge, highly precise release rates over 97% of its storage capacity with a rate deviation of only 1.1% can be achieved.

Production of tissue-engineered skin and oral mucosa for clinical and experimental use

Since the early 1990s, our understanding of how epithelial and stromal cells interact in 3D tissue-engineered constructs has led to tissue-engineered skin and oral mucosa models, which are beginning to deliver benefit in the clinic (usually in small-scale reconstructive surgery procedures) but have a great deal to offer for in vitro investigations. These 3D tissue-engineered models can be used for a wide variety of purposes such as dermato- and mucotoxicity, wound healing, examination of pigmentation and melanoma biology, and in particular, a recent development from this laboratory, as a model of bacterially infected skin. Models can also be used to investigate specific skin disease processes. In this chapter, we describe the basic methodology for producing 3D tissue-engineered skin and oral mucosa based on de-epidermised acellular human dermis, and we give examples of how these models can be used for a variety of applications.