Left Maxillae Research Articles

ELSABAGH SCORING SYSTEM FOR ASSESSING SEVERITY AND TREATMENT IMPROVEMENT IN MULTIPLE ORAL LICHEN PLANUS

Introduction: Lichen planus (LP) is a mucocutaneous, chronic, autoimmune disease, with various clinical manifestations, often involving the oral mucosa, and commonly occurs in adults 30-60 years old. Among the various scoring systems for oral lichen planus, the Elsabagh scoring system is valid, accurate, relatively easier to teach, relatively faster to master, and does not require complex calculations.Objective: This paper aimed to report and evaluate the successful therapy given based on using the Elsabagh scoring system in oral lichen planus. Case: A 53-years-old woman came to the Department of Oral Medicine with a main complaint of pain in the upper gums and lower right left a year ago. The pain got worse when eating highly spiced and spicy foods. She felt pain when brushing her teeth. Extra oral examination revealed multiple white plaques on the vermilion border. Intra-oral examination revealed erosive, erythema, accompanied by white plaques mesh-like shaped, irregular, and painful, on the upper labial, right and left buccal mucosa, posterior teeth of the mandible that extend into the mucobuccal fold, and gingiva, palate, and posterior gingiva of the right and left maxillae. Amalgam fillings were found on teeth 37 and 46 with plaque and calculus. Based on clinical features, the patient was diagnosed with Multiple Oral Lichen Planus of Erosive and Reticular type. Case management: The patient received topical and systemic corticosteroids, mouthwashes, and supplements. She was advised to stop eating highly spiced and spicy foods, replace amalgam filling with tooth-colored filling, scaling, and replace removable dentures with permanent dentures. The evaluation result using the Elsabagh scoring system showed an improvement from the value of 8 on the initial visit to 3 on the last visit. There was an improvement in the patient's condition after treatment based on evaluation using the Elsabagh scoring system in this case. The Elsabagh scoring system can correlate disease severity with subjective symptoms, allowing comparisons between the initial evaluation of lesions and treatment efficacy or disease progression in oral lichen planus. Keywords: Autoimmune, Elsabagh Scoring System, Oral Lichen Planus

Effect of a protease-activated receptor-2 antagonist (GB88) on inflammation-related loss of alveolar bone in periodontal disease.

Protease-activated receptor-2 (PAR2 ), a pro-inflammatory G-protein coupled receptor, has been associated with pathogenesis of periodontitis and the resulting bone loss caused by oral pathogens, including the keystone pathogen Porphyromonas gingivalis (P. gingivalis). We hypothesised that administration of a PAR2 antagonist, GB88, might prevent inflammation and subsequent alveolar bone resorption in a mouse model of periodontal disease. Periodontitis was induced in mice by oral inoculations with P. gingivalis for a total of eight times over 24 days. The infected mice were treated with either GB88 or vehicle for the duration of the trial. Following euthanasia on day 56, serum was collected and used for the detection of mast cell tryptase. The right maxillae were defleshed and stained with methylene blue to measure the exposed cementum in molar teeth. The left maxillae were prepared for cryosections followed by staining for tartrate-resistant acid phosphatase to identify osteoclasts or with toluidine blue to identify mast cells. Reverse transcription quantitative PCR (RT-qPCR) was used to quantify the expression of inflammatory cytokines in the gingival tissue. Supernatants of T-lymphocyte cultures isolated from the regional lymph nodes were assayed using a cytometric bead array to measure the Th1/Th2/Th17 cytokine levels. Measurement of the exposed cementum showed that GB88 reduced P. gingivalis-induced alveolar bone loss by up to 69%. GB88 also prevented the increase in osteoclast numbers observed in the infected mice. Serum tryptase levels were significantly elevated in both the infected groups, and not altered by treatment. RT-qPCR showed that GB88 prevented the upregulation of Il1b, Il6, Ifng and Cd11b. In T-lymphocyte supernatants, only IFNγ and IL-17A levels were increased in response to infection, but this was prevented by GB88 treatment. GB88 significantly reduced osteoclastic alveolar bone loss in mice infected with P. gingivalis, seemingly by preventing the upregulation of several inflammatory cytokines. PAR2 antagonism may be an effective treatment strategy for periodontal disease.

Maxillary abnormality in the medieval Blessed friar Egidio from Laurenzana (Basilicata, southern Italy)

AbstractBlessed Egidio was a revered Catholic friar who lived in Basilicata (southern Italy) between the 15th and 16th centuries A.D. His natural mummy is preserved in the Mother Church of Laurenzana, the village where he lived. During the recent restoration and conservation of the relic, palaeopathological analysis was carried out. This revealed osteolytic lesions that affected the maxillary bones, as two injuries that were different in morphology and size that distinctly afflicted the right and left maxillae. The macroscopic and radiographic appearance of the lesion on the right maxilla and its proximity to the right premolar tooth that showed periapical granuloma suggest a diagnosis of an inflammatory odontogenic cyst (radicular cyst). The second lesion, of the left maxilla, was non‐specific and might have been the consequence of an inflammatory process. Odontogenic cysts are common in modern human populations but have been poorly described to date in ancient populations. The case of Blessed Egidio represents a new and rare case diagnosed in the field of palaeopathology.

The Effects of Static Magnetic Field on Orthodontic Tooth Movement in Mice.

The application of static magnetic field (SMF) has been considered an effective and noninvasive method to accelerate orthodontic tooth movement. The objective of this study was to explore the effects of SMF on orthodontic tooth movement in mice. A total of 105 Balb/c mice (body mass: 25-30 g) were divided into experimental group (SMF + force, 48), control group (force only, 48), and blank group (neither SMF nor force, 9). After the placement of orthodontic appliances, the experimental group was exposed to the SMF environment generated by Neodymium-iron-boron (NdFeB) magnets with anintensity of 20-204 mT. At 1, 3, 7, 14, 21, and 28 days after appliance insertion, eight animals in both experimental and control groups were sacrificed and the left maxillae were dissected to measure the distance of tooth movement, respectively. Meanwhile, the width of periodontal ligament (PDL), length of hyalinized zone, and the number of osteoclasts were evaluated by hematoxylin-eosin and tartrate-resistant acid phosphatase staining. We finally found that the experimental group demonstrated an enhanced rate and greater cumulative amount of tooth movement than the control group (0.2887 ± 0.0041 mm vs. 0.2114 ± 0.0089 mm, P < 0.05). On Days 7, 14, and 28, the experimental group also displayed a significantly greater width of PDL. Earlier formation and removal of the hyalinized zone, and significantly more osteoclasts were observed in the experimental group as well. The results suggested that SMF may be a promising nonsurgical intervention to accelerate orthodontic tooth movement. © 2021 Bioelectromagnetics Society.

Local administration of high-dose diabetes medicine exendin-4 inhibits orthodontic tooth movement in mice.

To investigate the effects of exendin-4 on orthodontic tooth movement distance, root resorption, and expression levels of osteoclast-related cytokines in a mouse model. A 10-g NiTi coil spring was placed between the anterior alveolar bone and upper left first molar of 8-week-old male C57BL/6 mice. Twenty microliters of exendin-4 solution (containing 0.2 μg, 4 μg, or 20 μg exendin-4) or phosphate-buffered saline (PBS) were injected on the buccal side of the upper left first molar at 2-day intervals (4 mice per group). Mice were sacrificed on day 12; silicone impressions were taken to record tooth movement distance. The left maxillae of the PBS and 20 μg exendin-4 groups were also excised for histological analysis and quantitative reverse transcription polymerase chain reaction analysis. Orthodontic tooth movement distance was smaller in the 20 μg exendin-4 group than in the PBS group (P < .01). Compared with the PBS group, the 20 μg exendin-4 group showed lower osteoclast number (P < .05), odontoclast number (P < .05), and root resorption surface percentage (P < .05). Relative to maxillae with PBS injections, maxillae with 20 μg exendin-4 injections had lower receptor activator of nuclear factor kappa-B ligand (RANKL) mRNA expression (P < .05), TNF-α mRNA expression (P < .05), and RANKL/osteoprotegerin (OPG) ratio (P < .01). There were no differences in the expression of OPG mRNA. Exendin-4 inhibits orthodontic tooth movement. Therefore, additional attention is needed for orthodontic patients who receive exendin-4 for diabetes treatment. GLP-1 receptor may be a treatment target for patients with severe root resorption.

Proposal for a clinical diagnosis index in rapid palatal expansion (RPE) in childhood

Rapid palatal expansion (RPE) in childhood is indicated in children and teenagers with transverse maxillary deficiencies, often with skeletal antero-posterior and vertical anomalies, and functional abnormalities. The procedure consists of separating the right and left maxillae over two or three weeks. Curiously, orthodontists are using expansion appliances without any real indication; they use little RPE although it is the only effective treatment of true transverse maxillary deficiencies. Using clinical and radiological observations of many patients it was possible to devise a diagnostic index specifying the indications for semi-rapid palatal expansion. This quick and easy index composed of 4 items takes into account all the information necessary to establish a medical indication for rapid palatal expansion. It also allows practitioners to evaluate the effectiveness of the index by comparing scores before and after treatment. At present, there is no other comparable diagnostic tool. The objective of the index is to specify the medical indication of RPE and to reduce differences in the use of this therapy.

The Specific Morphological Features of Alveolar Bone.

The aim of the study was to study the specific morphological features of alveolar bone and compare it to femoral bone in rats. Twelve 3-month-old nonpregnant female Sprague-Dawley rats were used in the present study. The left maxillae and femurs of 6 rats were used for micro-computed tomography (micro-CT) scanning. The trabecular bone of the distal femur and the interradicular alveolar bone of the maxillary first molar were reconstructed and analyzed. Another 6 rats were used for histological analysis of trabecular bone and alveolar bone. Micro-CT analysis suggested that the femoral trabecular bone was porous with rod-like trabeculae with a scattered distribution in bone marrow, whereas alveolar bone showed a compact structure with plate-like trabeculae and limited bone marrow. Tissue mineral density, bone mineral density, bone volume fraction, and trabecular thickness were dramatically higher in the alveolar bone compared with that in the trabecular bone. Alveolar bone displayed lower trabecular number and trabecular separation. Histomorphometric analysis showed that alveolar bone was formed of compact bone with wide trabeculae, whereas femurs were composed of loose bone with finer trabeculae. In comparison to the spongiosa of the distal femur, alveolar bone displays specific morphological features with compact, wide, and highly mineralized trabeculae.

The Effect of Calendula officinalis on Oxidative Stress and Bone Loss in Experimental Periodontitis.

Periodontitis is associated with reduced antioxidant capacity and increased oxidative damage. Oxidative stress induces inflammation and bone loss contributing to the pathological progression of periodontal disease. Calendula officinalis (CLO) has demonstrated anti-inflammatory and anti-oxidant activities. Therefore, the aim of this study was to evaluate the effect of CLO on oxidative stress and bone loss in rats subjected to experimental periodontitis (EP). For this, 72 male Wistar rats were divided into groups: Naïve, Saline (SAL) and CLO. Rats received SAL or CLO (90 mg/kg) 30 min before ligature and daily until the 11th day. Naïve group experienced no manipulation. After 11 days, the animals were euthanized and left maxillae collected for macroscopic analysis of alveolar bone loss (ABL). Periodontium was analyzed by macroscopy, scanning electron microscopy; confocal and light polarized microscopy. Immunohistochemical examination of DKK1, WNT 10b and β-catenin was performed. The gingival tissue was collected to reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) and malondialdehyde (MDA) analyses. The 11 days of ligature induced bone loss, breakdown of collagen fibers, increased the immunostaining DKK-1 while reduced WNT 10b and β-catenin expressions. Periodontitis reduced GSH, SOD, CAT and increase MDA. All findings were reversed by 90 mg/kg of CLO. In summary our findings demonstrated that CLO reduced oxidative stress and bone loss and preserved collagen fibers in rats with EP, with participation of WNT signaling pathway.

Effects of glucocorticoid-induced osteoporosis on bone tissue of rats with experimental periodontitis

ObjectiveTo evaluate the effects of osteoporosis induced by glucocorticoid (GIOP) on bone tissue of rats with experimental periodontitis (EP). Design48 male Wistar rats divided into groups: Naïve, EP, GIOP and GIOP+EP. Rats of GIOP and GIOP+EP groups received 7mg/kg of dexamethasone intramuscularly once a week for 5 weeks. Following, EP and GIOP+EP groups were subjected to ligature-induced periodontitis. Naïve group experienced no manipulation. After 11 days, the animals were euthanized and left maxillae collected for macroscopic, radiographic, micro-tomographic and microscopic analysis of alveolar bone loss (ABL). Blood samples were collected for determination of bone-specific alkaline phosphatase (BALP) levels and the right femurs were removed for radiographic and biomechanical analysis. ResultsEP caused ABL and reduced BALP levels (p<0,05), but it did not change the architecture or biomechanics of femur, compared to Naïve. GIOP did not cause ABL, but it significantly decreased alveolar bone mineral density (ABMD), bone percentage and trabecular thickness (Tb.Th) and increased alveolar bone porosity (p<0.05) and significantly reduced BALP serum levels, as well as radiographic density and Young’s module of femur, compared to Naïve. There was a greater ABL in group GIOP+EP when compared to EP (p<0.05). GIOP+EP caused a greater decrease on ABMD, Tb.Th, bone percentage and increased bone porosity (p<0.05) and also presented a significant reduction in BALP levels (p<0.05), in radiographic density and in Young’s module of femur compared to EP (p<0.05). ConclusionsGIOP can potentiate the destructive effects of EP on alveolar bone and alter the systemic bone loss, by promoting bone resorption and reducing osteoblast activity.

A radiological evaluation of alveolar bone regeneration between the left and right mandibles and maxillae of the Chacma baboon.

There is a lack of information in comparing the healing rate between the left and right sides of the maxilla and mandible. Osteogenesis of alveolar bone was evaluated with digital radiology by comparing differences in bone density (BD) at different time points within the left and right maxilla and mandible. Alveolar bone defects were created in five healthy Chacma baboons. Standardised x-ray images were acquired over time and the densities of the selected trauma areas were measured pre-operatively, post-operatively and at 3 and 6 weeks post-operatively. Differences in densities were statistically tested. There was no significant difference when the grey scale averages of the combined first and fourth quadrants (right side) and combined second and third quadrants (left side) were compared pre-operatively (t = 0.70), immediately post-operatively (t = 0.34), 3 weeks post-operatively (t = 0.40) and 6 weeks post-operatively (t = 0.66). There was also no significant difference between the values for the first and second quadrants (maxilla) pre-operatively (t = 0.37), immediately post-operatively (t = 0.30), 3 weeks post-operatively (t = 0.30) and 6 weeks post-operatively (t = 0.38); the third and fourth quadrants (mandible) were also not significantly different pre-operatively (t = 0.29), immediately post-operatively (t = 0.69), 3 weeks post-operatively (t = 0.07) and 6 weeks post-operatively (t = 0.06). However, the results showed an increased predisposition of the right side to regenerate faster than the left side and indicated sufficient information to investigate the effect of laterality and preferred side of mastication on the rate of healing and alveolar BD in the maxilla and mandible.

Odontogenic dysplasia in the molar teeth of Steppe lemmings (Lagurus lagurus)

In a colony of Steppe lemmings (Lagurus lagurus), of the rodent sub-family Arvicolinae, 8.6% of animals exhibited dysplastic growth of the molar teeth. Clinical findings included nodular swellings of the mandible, hypersalivation, malocclusion and emaciation. To investigate the underlying cause, two control and 10 affected animals, aged between 6 and 18 months, were examined using radiography and computed tomography and at post mortem examination. Bilaterally symmetrical masses were identified in the molar regions of the left and right mandible and maxillae. Histologically, the masses were characterised by dysplastic odontogenic epithelium, dentin, cementum, enamel and dental pulp formation that resembled odontogenic dysplasia. This tumour-like proliferative lesion has been reported in the continuously-growing incisor teeth of ageing rodents and lagomorphs but this is the first description of the clinico-pathological features of such odontogenic dysplasia of the molar teeth of Steppe lemmings.

The thickness and the lengths of the anterior wall of adult maxilla of the West Anatolian Turkish people

The maxilla is the key structure on facial formation and stability. The knowledge about maxillary thickness and dimensions is crucial during facial reconstruction including this bone. In this study, anthropometric measurements of anterior wall of the maxilla on the dry human skulls were aimed. Sixty maxillae of 30 adult dry skulls of West Anatolian people were evaluated. Four vertical lines were drawn between the piriform aperture and lateral border of the bone and six horizontal lines between the infra-orbital margin and the inferior border of the piriform aperture. After establishing the lines, maxillary thicknesses on the intersection points of the vertical and horizontal lines and the lengths of the vertical lines from the infra-orbital margin to alveolar arch were measured by using a fine caliper. It was found that the thickest point of the anterior wall of the maxillae is on the lateral of the infra-orbital margin (5.17 +/- 2.27 mm), and thinnest one is on the inferior of the infra-orbital foramen (0.92 +/- 1.06 mm). The length of the vertical line tangent to piriform aperture (47.66 +/- 3.61 mm) is the longest. The corresponding data of the left and right maxillae were compared by Student's t test. There was no significant difference between both sides. After collecting the data, a thickness map of anterior wall of the maxilla was drawn. This data may be helpful in clinic during osteotomies, bone reconstructions, screw, or other reconstruction apparatus applications on the maxilla.

Celebrex Offers a Small Protection From Root Resorption Associated With Orthodontic Movement

Tooth movement results from alveolar bone resorption/deposition following application of orthodontic forces, and root resorption can be an undesirable complication associated with this process. No treatment for external root resorption is available to date. To determine if COX-2 inhibitors like Celebrex are effective in protecting root resorption associated with orthodontic forces. A force of 80 grams was applied to the left maxillary first molars of 7-week-old female Wistar rats using nickel titanium closed coil springs attached to the cervical area of the incisors with 0.010 stainless-steel ligature wires. Twenty animals were divided into three experimental groups: one receiving no treatment, the second receiving 25mg/kg, and the third receiving 50 mg/kg of celecoxib (Celebrex) in their drinking water. Rats were maintained on a soft diet and euthanized two weeks after initial placement of the force. Paraffin-embedded sections of the right (control) and left (experimental) maxillae were stained with H&E and the areas of root resorption were examined by counting the number of lacunaes in the roots. No difference in the distance of tooth movement (0.5 mm/two weeks) was seen in all three groups. The rats that received the low dose of Celebrex showed no statistically significant difference in root resorption than that of the rats that received no dose. The rats that received the high dose of Celebrex showed a lower number of lacunaes (mean = 3.5) than that of the control group (mean 10.2; p=0.02). Administration of Celebrex during the application of orthodontic forces does not interfere with tooth movement and appears to offer some slight protection against root resorption.

Effect of soluble receptors to interleukin-1 and tumor necrosis factor alpha on experimentally induced root resorption in rats.

In this study, the role of the inflammatory cytokines interleukin-1 (IL-1) and tumor necrosis factor alpha (TNFalpha) in the course of mechanically induced root resorption was investigated. Mechanical induction of root resorption was performed on the upper left first molars in 18 male Wistar rats according to the method of Nakane and Kameyama. Starting on day minus 1, six animals received daily intraperitoneal injections of 2 ml of 1 micro g/ml soluble receptors to IL-1 (sIL-1RII) and another six animals were administered the same dose of soluble receptors to TNFalpha (sTNFalpha-RI). Six animals served as a control. On d 7 the left maxillae were prepared for histological and morphometric analysis of the extent of the root resorption that had developed. The qualitative and quantitative results demonstrated that in both receptor groups the amount of root resorption was significantly reduced. Especially following systemic application of sTNFalpha-RI, root resorption was nearly completely prevented. Our results indicate that IL-1 and more particularly TNFalpha are important for the induction and the further process of mechanically induced root resorption in the rat.

Maxillary sinusitis as an indicator of respiratory health in past populations.

Chronic infectious respiratory disease in a past human population is investigated through the quantification of maxillary sinusitis among Iroquoian horticulturists. Three hundred forty-eight right and left maxillae of a Southern Ontario Iroquoian skeletal sample, Uxbridge Ossuary, ca. AD 1440, were examined for evidence of chronic infection (minimum number of individuals = 207: 114 adults, 22 adolescents, 38 juveniles and 33 infants). Modern clinical criteria were applied to differentiate lesions of respiratory and dental origin. Osseous lesions of the maxillary sinuses were observed in 50% of the individuals examined. These lesions are morphologically consistent with nonspecific lesions observed in other past populations that have been attributed to the presence of pathogens. The prevalence of maxillary sinusitis increases with age. Osseous changes suggestive of maxillary sinusitis of respiratory origin are at a maximum prevalence in juveniles and adolescents. In adults, infection of dental origin becomes a confounding factor in the identification of sinusitis of respiratory origin. Fifteenth century Iroquoians were experiencing high airborne pathogen levels and poor indoor air quality. The prevalence of maxillary sinusitis and the exploration of the origin of tissue injury may contribute to our reconstruction of the quality of life and the respiratory health status of past human populations.

Modes of algal capture by the freshwater copepod Diaptomus sicilis and their relation to food‐size selection1,2

High‐speed motion pictures (500 frames s−1) of tethered Diaptomus sicilis feeding in suspensions of Chlamydomonas spp. of three different sizes at three different concentrations (0.3, 1.0, and 3.0 mm3 liter−1), showed two modes of feeding: a passive mode in which algae flowed into the space between the left and right second maxillae and an active mode in which the second maxillae or second maxillae plus maxilliped made large amplitude flaps to bring in the cell. Cells ≤4 µm in diameter were always captured passively, and cells ≥6 µm were captured both actively and passively. Active captures were 18% of total captures for the medium‐sized (6 µm) algae and 36% for the large (12 µm) algae. During passive captures, algae usually flowed through the space between the left and right second maxillae rather than being caught on the setules; thus, the leaky‐sieve model of particle retention does not apply for passive captures by D. sicilis. Except for brief interruptions to actively capture a large alga nearby, the second maxillae of D. sicilis oscillated continuously at low amplitude at all times during feeding, in marked contrast to the marine copepods Eucalanus and Paracalanus that vibrated their second maxillae to enhance capture in monocultures of small algae but not large algae. These observations explained both the shape of the curve of selectivity vs. particle size for D. sicilis and its relative invariance. Analyses of feeding mechanisms and the water currents around Diaptomus showed that, in contrast to Eucalanus and Paracalanus, Diaptomus is specialized for capturing small particles, which may be a more important food in freshwater than in marine environments.

The effects of orthopedic forces on the craniofacial complex utilizing cervical and headgear appliances

1. A three-dimensional anatomic model of a human skull was produced with birefringent materials for photoelastic analysis. By means of photoelastic techniques during application of high-pull and cervical extraoral traction, stresses were visualized within the model. 2. Extraoral anchorage affected the position of the maxillary molar and its resulting alveolar development. Cervical headgear had a much greater tipping effect on the maxillary molar than did the high-pull headgear. Both appliances examined could produce stresses which may be transmitted to distant eraniofacial sutures. As opposed to high-pull traction, cervical pull in general stressed more areas and to a much greater degree. 4. The pterygoid plates of the sphenoid bone, the zygomatic arches, the junction of the maxilla with the lacrimal bone and the ethmoid, and the maxillary teeth were affected by both types of headgear. 5. Only cervical traction produced stresses at the frontal process of the maxilla and the Zygomaticofrontal suture. 6. There were two findings which had not been previously reported: First, cervical traction tended to open the palate in the posterior region. Second, high-pull traction produced compressive stresses at the junction of the right and left maxillae inferior to the anterior nasal spine.

Cell proliferative activity of injured periodontal tissue. An H3-thymidine autoradiographic study of 26-week-old mice following gingivectomy.

Fifty‐six, female, BNL strain mice, 26 weeks of age, received a modified “gingiveclomy” excising, the gingival papilla mesial to the maxillary left first molar. The right maxillae served as the uninjured control site. Additional non‐injured mice were utilized as further controls. At varying time intervals, groups containing 4 mice each were sacrificed over a 3 months experimental period. One hour prior to sacrifice, each animal received a subcutaneous injection of 1 uCi of H3TDR/gm of body weight. At sacrifice, both left and right maxillae were dissectedd out and prepared for histologic and autoradiographic study. Following injury, the highest proliferative activity was encountered at the epithelial wound edge. This activity became prominent about 8 to 15 days after injury, while the adjacent crestal epithelium demonstrated a markedly increased activity as early as 16 hours after wounding. The reformed junctional and crevicular epithelium, and adjacent fibroblasts, still exhibited elevated activity at one month post‐injury and returned to control range values between one and three month following wounding. The remaining fibroblasts, osteoblasts and cementoblasts around the wound periphery showed markedly elevated activity as early as one to two days post‐injury which returned to control levels between 2 to 4 weeks after wounding.