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OBJECTIVE Oral wound healing in healthy could be promoted by VEGF in saliva, and immediate denture wearing, but data in type 2 diabetes are lacking. Aims were to investigate the timeline of extraction wound healing in diabetic participants wearing immediate dentures and its correlation to salivary VEGF, as well as to examine the impact of the palatal plate on tissue VEGF during palatal wound healing in rat diabetic model. MATERIAL AND METHODS Healthy (42) and type 2 diabetic (36) denture wearers, candidates for teeth extractions were included. Extraction wound healing was followed via measurements of socket closure, gingival hyperaemia, pain and presence of necrosis on 3rd, 7th, 14th and on 21st-day post-extraction. Salivary VEGF was measured before and on the 3rd and 21st day after the extraction. In streptozotocin-induced diabetic (30) as well as non-diabetic rats (30), tissue VEGF was measured in palatal wounds healing under or without a palatal plate. RESULTS Type 2 diabetic prosthetic patients exhibit delayed socket closure, with pronounced hyperaemia, pain and necrosis. Salivary VEGF is increased in diabetes and positively correlates to socket closure while negatively with pain on 21st day after the extraction. Palatal incision induced VEGF increase in non-diabetic and diabetic, but less pronounced in diabetic rats. Wound healing under the palatal plate exhibit higher tissue VEGF. CONCLUSION Type 2 diabetes-induced increase in salivary VEGF may mitigate diabetes-induced detrimental effects on extraction wound healing. Lack of adequate tissue VEGF response to injury may underly dysregulation of diabetic oral wound healing.

Background/Aim. Alveolar ridge dimensional alterations following tooth extraction in the anterior maxilla often result in an inadequate bone volume for a correct implant placement. In order to obtain optimal bone volume various bone graft substitutes have become commercially available and widely used for socket grafting. The aim of this study was to examine and compare long-term clinical outcomes of dental implant therapy in the maxillary esthetic zone, after socket grafting with beta-tricalcium phosphate (TCP) combined with collagen type I, either with or without barrier membrane and flap surgery, after a 12-month follow-up. Methods. Twenty healthy patients were allocated to either C group (beta-TCP and type I collagen without mucoperiosteal flap coverage) or C+M group (beta-TCP and type I collagen barrier membrane with mucoperiosteal flap coverage). Following clinical parameters were assessed: implant stability (evaluated by a resonance frequency analysis - RFA), periimplant soft tissue stability (sulcus bleeding index - SBI, Mombelli sulcus bleeding index - MBI, periimplant sulcus depth, keratinized gingiva width, gingival level) and marginal bone level at the retroalveolar radiograms. Results. Within C+M group, RFA values significantly increased 12 weeks after implant installation compared to primary RFA values. Comparison between investigated groups showed a significantly reduced keratinized gingiva width in the C+M group compared to the C group after 3, 6, 9 and 12 months. Comparison between groups revealed significantly lower gingival level values in the C+M group at 9th and 12th month when compared to the C group. Conclusion. Implant treatment in the anterior maxilla could be effective when using a 9 months alveolar ridge preservation healing with combined treatment with beta-tricalcium phosphate and type I collagen, with regard to the peri-implant soft and hard tissue stability., Uvod/Cilj. Posle ekstrakcije zuba, dimenzionalne promene alveolarnog grebena u estetskoj regiji gornje vilice za posledicu često imaju nedovoljnu količinu kosti za ugradnju zubnih implanata. U vezi sa tim, primenjuju se različiti koštani zamenici sa ciljem očuvanja dimenzija alveolarnog grebena posle ekstrakcije zuba. Cilj rada bio je da se, posle prezervacije alveolarnog grebena beta-trikalcijum fosfatom (TCP) sa kolagenom tip 1, sa barijernom membranom i mukoperiostalnim režnjem i bez nje, ispitaju i uporede klinički ishodi zarastanja posle ugradnje zubnih implanata u estetskoj regiji gornje vilice, tokom jednogodišnjeg perioda praćenja. Metode. Dvadeset zdravih bolesnika podeljeno je u dve grupe: C (beta TCP/kolagen tip 1 bez barijerne membrane i mukoperiostalnog režnja) i C+M (beta TCP/kolagen tip 1 sa barijernom membranom i mukoperiostalnim režnjem). Praćeni su uobičajeni klinički parametri ishoda terapije: implantna stabilnost (analiza rezonantne frekvence), stanje mekih tkiva (indeks krvarenja, plak indeks, širina pripojne mukoze, recesija gingive) i nivo periimplantnog koštanog tkiva na retroalveolarnom radiogramu. Rezultati. U C+M grupi, implantna stabilnost posle 12 nedelja bila je značajno veća u odnosu na primarnu stabilnost. U C+M grupi, širina keratinizovane gingive bila je značajno manja posle 3, 6, 9 i 12 meseci u odnosu na C grupu. Recesija gingive bila je značajno veća u C+M grupi u odnosu na C grupu posle 9 i 12 meseci. Zaključak. Razmatrajući stabilnost mekog i tvrdog periimplantnog tkiva, terapija zubnim implantima može biti uspešna prilikom ugradnje u estetskoj regiji gornje vilice.

Objective We aimed to investigate alteration in cellular signaling mediated by vascular endothelial growth factor (VEGF) and parameters of oxidative stress/nitric oxide generation, superoxide dismutase (SOD) and neuronal nitric oxide synthase (nNOS), underlying altered functional mechanical loading of TMJ (temporomandibular joint) during lateral mandibular deviation. Design Thirty-eight 5-week-old male Wistar rats were divided into experimental group, which received acrylic resin appliance that shifted mandible to the left during closure, and control group. Computed tomography and histomorphometry were used for condyle analyses, while samples of condyle, synovial membrane and m. masseter were analyzed with enzyme–linked immunosorbent assay and spectrophotometry to determine VEGF and nNOS protein concentrations, and SOD activity. Results Experimental group of rats developed smaller and asymmetrical mandibles. Less of new bone and cartilage formation and larger bone marrow cavities area were found in the experimental group. Higher VEGF expression in condyle and m. masseter as well as higher nNOS expression in m. masseter and synovial membrane were found in the experimental compared to the control group. Alteration of SOD activity was found in m. masseter and synovial membrane in the experimental group. Conclusions Lateral mandibular deviation induces mandibular and condylar morphological changes as well as significant cellular signaling alterations in condyle, synovial membrane and masticatory muscle. Cellular VEGF protein overexpression and oxidative stress/nitric oxide disbalance could be the mechanisms underlying unbalanced functional TMJ loading due to mandibular deviation.

AimTo investigate melatonin (MEL) levels in human dental pulp tissue (hDP) in type 2 diabetic (T2D) participants and the underlying molecular mechanisms of its effects in human dental pulp cells (hDPCs) under hyperglycaemia. MethodologyThe study included 16 healthy and 16 T2D participants who underwent vital pulp extirpation for hDP and four healthy participants undergoing third molar extraction for hDPCs analyses. MTT and NRU were used as tests for cytotoxicity. The pulp tissue levels of MEL, inducible NO synthase (iNOS) and superoxide dismutase (SOD) activity, as well as iNOS, histone acetyltransferase p300 (p300) and SOD activity levels in hDPCs incubated with MEL (0.1 and 1.0mmolL(-1)) under normoglycaemia and hyperglycaemia were measured by enzyme-linked immunosorbent assay. Comparisons between the two groups were made by unpaired t-tests or Mann-Whitney test whilst the chi-square test was used for dichotomous variables. To compare more groups, the Kruskal-Wallis test with Dunn's multiple comparison was used, whilst Spearman correlation was used to assess association between two variables. ResultsMelatonin was decreased (124.3021.6 vs. 240.0 +/- 19.1 pgmL(-1), P lt 0.01), whilst iNOS levels increased (0.92 +/- 0.08 vs. 0.32 +/- 0.09ngmL(-1), P lt 0.01) in hDP from T2D compared to nondiabetic participants. In hDPCs, MEL (0.1 and 1.0mmolL(-1)) had no cytotoxicity. Incubation with 1.0mmolL(-1) of MEL (24h) decreased hyperglycaemia-induced increases of iNOS (0.34 +/- 0.01ngmL(-1) vs. 0.40 +/- 0.01ngmL(-1), P lt 0.01) and p300 (11.59 +/- 0.58ngmL(-1) vs. 16.12 +/- 0.39ngmL(-1), P lt 0.01), and also, increased SOD activity (87.11 +/- 3.10% vs. 68.56 +/- 3.77%, P lt 0.01) to the levels comparable to the normoglycaemic; iNOS and p300 protein expression levels showed strong positive correlation under hyperglycaemia (Spearman r=0.8242, P lt 0.001). ConclusionType 2 diabetic participants had decreased MEL in hDP. At pharmacological concentrations, MEL is not cytotoxic for hDPCs and normalizes iNOS and SOD activity levels in hyperglyceamic hDPCs suggesting its antioxidant and protective effects in human dental pulp tissue under hyperglycaemia.

Objective.Leukocyte- and platelet-rich fibrin (L-PRF) represents a natural, low-cost product which may promote tissue healing by mechanisms not fully elucidated. Diabetes mellitus (DM) disrupts bone healing by inducing inflammation and oxidative stress (OS), mechanisms regulated by microRNAs (miRs). The aim of the present study was to investigate the microRNA-21 (miR-21) involvement in diabetic bone regeneration using L-PRF alone or in combination with a standard grafting material. Design.After the induction of diabetes (alloxan 100 mg/kg), four cranial osteotomies were made in diabetic (n = 12) and non-diabetic (n = 12) rabbits: one was left empty and the remaining three were grafted with L-PRF, bovine hydroxyapatite (Bio-Oss®) and L-PRF + Bio-Oss®. Two and eight weeks postoperatively, the samples were harvested for miR-21 expression (Real-time RT-PCR) and enzyme-linked immunosorbent assay analyses. Results.Diabetic rabbits showed decreased miR-21 and matrix metalloproteinase-9 (MMP-9) protein expression while increased malondialdehyde (MDA) levels two weeks postoperatively; however, there were no significant differences in miR-21 and MMP-9 levels between diabetic and non-diabetic rabbits in samples taken eight weeks postoperatively. Application of L-PRF and L-PRF + Bio-Oss®improved miR-21 and MMP-9 and decreased MDA levels while Bio-Oss® alone enhanced superoxide dismutase (SOD) activity levels in diabetic rabbits. Conclusion.L-PRF alone or in combination with bovine hydroxyapatite as bone graft could be beneficial in DM since it seems to improve inflammation-modulatory miR-21 expression and decreases oxidative stress.

gamma-Aminobutyric acid type A (GABA(A)) receptors containing the alpha 6 subunit are located in trigeminal ganglia, and their reduction by small interfering RNA increases inflammatory temporomandibular and myofascial pain in rats. We thus hypothesized that enhancing their activity may help in neuropathic syndromes originating from the trigeminal system. Here, we performed a detailed electrophysiological and pharmacokinetic analysis of two recently developed deuterated structurally similar pyrazoloquinolinone compounds. DK-I-56-1 at concentrations below 1 mu M enhanced gamma-aminobutyric acid (GABA) currents at recombinant rat alpha 6 beta 3 gamma 2, alpha 6 beta 3 delta and alpha 6 beta 3 receptors, whereas it was inactive at most GABA(A) receptor subtypes containing other alpha subunits. DK-I-87-1 at concentrations below 1 mu M was inactive at alpha 6-containing receptors and only weakly modulated other GABA(A) receptors investigated. Both plasma and brain tissue kinetics of DK-I-56-1 were relatively slow, with half-lives of 6 and 13 hr, respectively, enabling the persistence of estimated free brain concentrations in the range 10-300 nM throughout a 24-hr period. Results obtained in two protocols of chronic constriction injury of the infraorbital nerve in rats dosed intraperitoneally with DK-I-56-1 during 14 days after surgery or with DK-I-56-1 or DK-I-87-1 during 14 days after trigeminal neuropathy were already established, demonstrated that DK-I-56-1 but not DK-I-87-1 significantly reduced the hypersensitivity response to von Frey filaments. Significance Neuropathic pain induced by trigeminal nerve damage is poorly controlled by current treatments. DK-I-56-1 that positively modulates alpha 6 GABA(A) receptors is appropriate for repeated administration and thus may represent a novel treatment option against the development and maintenance of trigeminal neuropathic pain.

AimRecent studies point at the crucial role of epigenetic mechanisms in the development of multifactorial diseases such as periodontitis and diabetes mellitus (DM) type 2. In addition, circulatory microRNAs (miRs) have emerged as novel biomarkers for various diseases. Aim of this study was to investigate the levels of miR-146a and miR-155 and superoxide dismutase (SOD) activity in gingival crevicular fluid (GCF) of periodontitis patients with (CPDM) and without (CP) DM type 2 as well as in periodontally healthy, control groups (PHDM and PH, respectively). Material and methodsmiR modulation was analysed using quantitative real-time PCR while SOD activity was measured spectrophotometrically. ResultsThe upregulation of miR-146a and miR-155 was observed in CP and CPDM patients' baseline, while the levels decreased after 6weeks of the non-surgical therapy to the levels comparable to PH and PHDM, respectively. Expression levels of miRs positively correlated with SOD activity. Levels of miR-146a were higher in PHDM compared to PH patients. Multivariate analysis revealed that levels of miR-146a and miR-155 were significantly associated with periodontitis when adjusting for age and gender. ConclusionsmiR-146a and miR-155 may be considered as possible novel biomarkers for periodontitis in non-diabetic and type 2 diabetic patients., This is the peer-reviewed version of the article: Radović, N.; Nikolić-Jakoba, N.; Petrović, N.; Milosavljević, A.; Brković, B.; Roganović, J. MicroRNA-146a and MicroRNA-155 as Novel Crevicular Fluid Biomarkers for Periodontitis in Non-Diabetic and Type 2 Diabetic Patients. Journal of Clinical Periodontology 2018, 45 (6), 663–671. [https://doi.org/10.1111/jcpe.12888]

Introduction. Therapeutic approach to jaw cysts may depend on their dimensions and localization. Enucleation of cystic lesion is not always preferable in the first act, especially if large cysts are in close proximity to important anatomical structures. The aim of this paper was to present the outcome of the treatment protocol comprising preoperative decompression and subsequent enucleation of a large maxillary cyst. Case report. A 21-year-old male patient with large asymptomatic radicular cyst in the right maxillary sinus was presented to our clinic. Cone-beam computed tomography (CBCT) showed a large cyst, which perforated the right anterior maxillary wall by 1.5 cm, and was in the intimate contact with the orbital floor. Surgical treatment of the cystic lesion comprised: preoperative decompression with biopsy in the first act and enucleation, performed under general anesthesia, 6 months after the observation period. Conclusion. Decompression with subsequent enucleation proved to be effective treatment of large radicular cyst in maxillary sinus with low-morbidity. [Projekat Ministarstva nauke Republike Srbije, br. 175021]

Statement of problem. Diabetes mellitus type 2 is associated with a variety of oral mucosal changes, including an altered level of salivary vascular endothelial growth factor. However, the authors identified no studies concerning denture stomatitis and salivary vascular endothelial growth factor in immediate denture wearers with diabetes mellitus type 2. Purpose. The purpose of this study was to investigate the incidence of and risk factors for denture stomatitis in immediate complete denture wearers with and without diabetes mellitus type 2 and to investigate the relationship between levels of salivary vascular endothelial growth factor and clinical forms of denture stomatitis in both groups. Material and methods. Individuals without diabetes (n=42) or with diabetes mellitus type 2 (n=36) who were candidates for complete immediate dentures were included in the study. After 1 year of wearing relined immediate dentures, participants were evaluated for denture stomatitis and potential contributing factors. Salivary vascular endothelial growth factor levels were measured with enzyme-linked immunosorbent assays. Data were analyzed with the chi(2) test or the Student t test where appropriate, as well as with binary logistic regression analysis. Results. The incidence of denture stomatitis was 61% in participants with diabetes mellitus type 2 and 38% in those without diabetes. Low denture stability and diabetes mellitus type 2 were risk factors for denture stomatitis. Salivary vascular endothelial growth factor concentrations at the beginning of the study were 557.6 +/- 94.7 pg/mL in participants with diabetes mellitus type 2 and 103.5 +/- 21.6 pg/mL in those without diabetes. In Newton Type I and Newton Type II denture stomatitis, vascular endothelial growth factor levels were 460.9 +/- 55.4 pg/mL and 1445.2 +/- 422.1 pg/mL in individuals with diabetes and 73.2 +/- 10.0 pg/mL and 306.5 +/- 22.6 pg/mL in those without diabetes. Conclusions. Perceived denture stability and diabetes mellitus type 2 are independent risk factors for the occurrence of denture stomatitis. Altered salivary vascular endothelial growth factor levels and denture stomatitis are more prevalent in denture wearers with diabetes mellitus type 2.

Biphasic calcium phosphates (BCP) are widely used in alveolar ridge regeneration as a porous scaffold for new bone formation. The aim of this case series was to evaluate the regenerative effect of the combination of BCP and polylactide-co-glycolide (PLGA) which can serve as a barrier membrane during bone regeneration. The study included five patients. Four months into the healing period, bone samples were collected for histological and morphometric analyses. The results of morphometric analysis showed that newly formed bone represented 32.2 ± 6.8% of the tissue, 31.9 ± 8.9% was occupied by residual graft and 35.9 ± 13.5% by soft tissue. Active osteogenesis was seen around the particles of the graft. The particles were occupied mostly by immature woven bone and connective tissue. The quality and quantity of newly formed bone, after the use of BCP/PLGA for ridge preservation, can be adequate for successful implant therapy after tooth extraction. [Projekat Ministarstva nauke Republike Srbije, br. OI 175021 i br. OI 173009]

Background/Aim. The mechanism of impaired bone healing in diabetes mellitus includes different tissue and cellular level activities due to micro- and macrovascular changes. As a chronic metabolic disease with vascular complications, diabetes affects a process of bone regeneration as well. The therapeutic approach in bone regeneration is based on the use of osteoinductive autogenous grafts as well as osteoconductive synthetic material, like a β-tricalcium phosphate. The aim of the study was to determine the quality and quantity of new bone formation after the use of autogenous bone and β-tricalcium phosphate in the model of calvarial critical-sized defect in rabbits with induced diabetes mellitus type I. Methods. The study included eight 4-month-old Chincilla rabbits with alloxan-induced diabetes mellitus type I. In all animals, there were surgically created two calvarial bilateral defects (diameter 12 mm), which were grafted with autogenous bone and β-tricalcium phosphate (n = 4) or served as unfilled controls (n = 4). After 4 weeks of healing, animals were sacrificed and calvarial bone blocks were taken for histologic and histomorphometric analysis. Beside descriptive histologic evaluation, the percentage of new bone formation, connective tissue and residual graft were calculated. All parameters were statistically evaluated by Friedman Test and post hock Wilcoxon Singed Ranks Test with a significance of p lt 0.05. Results. Histology revealed active new bone formation peripherally with centrally located connective tissue, newly formed woven bone and well incorporated residual grafts in all treated defects. Control samples showed no bone bridging of defects. There was a significantly more new bone in autogeonous graft (53%) compared with β-tricalcium phosphate (30%), (p lt 0.030) and control (7%), (p lt 0.000) groups. A significant difference was also recorded between β-tricalcium phosphate and control groups (p lt 0.008). Conclusion. In the present study on the rabbit grafting model with induced diabetes mellitus type I, the effective bone regeneration of critical bone defects was obtained using autogenous bone graft., Uvod/Cilj. Mehanizam otežanog zarastanja tkiva kod dijabetesa melitusa zasnovan je na različitim promenama funkcije na tkivnom i ćelijskom nivou, usled prisutnih mikro- i makrovaskularnih promena. Kao hronično metaboličko oboljenje sa vaskularnim komplikacijama, dijabetes melitus zahvata i proces koštane regeneracije. Terapijski postupci u okviru regeneracije kosti obuhvataju primenu autotransplantata sa oseoinduktivnim delovanjem i sintetskih osteokonduktivnih materijala, kao što je i β-trikalcijum fosfat. Cilj ovog rada bio je da se ispita kvantitet i kvalitet novoformiranog koštanog tkiva posle korišćenja autotransplantata kosti i β-trikalcijum fosfata, na modelu kritičnog defekta kalvarije kunića sa eksperimentalno izazvanim dijabetesom melitusom tipa I. Metode. U ovo istraživanje bilo je uključeno 8 kunića (soj Činičila), starosti 4 meseca, kod kojih je dijabetes melitus tipa I bio izazvan aloksanom. Kod svih životinja hirurški je urađen defekt kritičneveličine na kosti kalvarije (prečnika 12 mm), koji je popunjen autotransplantatom kosti i β-trikalcijum fosfatom (n = 4) ili je ostavljen da spontano zarasta kao kontrolni defekt (n = 4). Posle 4 nedelje, sve životinje su bile žrtvovane i koštani uzorci uzeti za histološku i histomorfometrijsku analizu. Pored deskriptivne histološke analize, urađena je i kvantitativna analiza novoformirane kosti, vezivnog tkiva i materijala za koštanu regeneraciju. Statistička analiza vršena je primenom Friedmanovog testa i post hock Vilkoksonovog neparametrijskog testa sa stepenom značajnosti od p lt 0,05. Rezultati. Histološka analiza uzoraka kosti pokazala je prisustvo novoformirane kosti na periferiji defekta, dok je u centralom delu bilo prisutno vezivno tkivo, nezrelo koštano tkivo i dobro sjedinjeni neresorbovani materijal za regeneraciju kosti. Kontrolni uzorci nisu pokazali koštano zarastanje defekata. Značajno više novoformirane kosti bilo je prisutno u defektima regenerisanim autotransplantatom (53%) u poređenju sa kontrolnim defektima (7%), (p lt 0,000) i defektima popunjenim β-trikalcijum fosfatom (30%), (p lt 0,030). Takođe, značajna razlika uočena je i između grupe sa β-trikalcijum fosfatom i kontrolnim koštanim defektom (p lt 0,008). Zaključak. Primena autotransplantata kosti značajno povećava uspešnost regeneracije kritičnih defekata kosti kalvarije kunića sa dijabetesom melitusom tipa I.

Introduction. The material used for root-end filling has to be biocompatible with adjacent periapical tissue and to stimulate its regenerative processes. Tricalcium silicate cement (TSC), as a new dental material, shows good sealing properties with dentin, high compression strengths and better marginal adaptation than commonly used root-end filling materials. Although optimal postoperative healing of periapical tissues is mainly influenced by characteristics of end-root material used, it could sometimes be affected by the influence of systemic diseases, such as diabetes mellitus (DM). Case report. We presented apical healing of the upper central incisor, retrofilled with TSC, in a diabetic patient (type 2 DM) with peripheral neuropathy. Standard root-end resection of upper central incisor was accompanied by retropreparation using ultrasonic retrotips to the depth of 3 mm and retrofilling with TSC. Postoperatively, the surgical wound healed uneventfully. However, the patient reported undefined dull pain in the operated area that could possibly be attributed to undiagnosed intraoral diabetic peripheral neuropathy, what was evaluated clinically. Conclusion. Although TSC presents a suitable material for apical root-end filling in the treatment of chronic periradicular lesions a possible presence of systemic diseases, like type 2 DM, has to be considered in the treatment outcome estimation., Uvod. Materijal koji se koristi za retrogradnu opturaciju kanala korena trebalo bi da bude biokompatibilan sa okolnim periapeksnim tkivom i da stimuliše procese njegove regeneracije. Trikalcijum silikatni cement (TSC), kao novi dentalni materijal, pokazuje dobro zaptivanje, visoku kompresivnu snagu i bolju ivičnu adaptaciju u odnosu na standardno korišćene materijale za retroopturaciju. Iako postoperativno zarastanje periapikalnog tkiva najviše zavisi od karakteristika materijala za retroopturaciju, ponekad na uspeh zarastanja može uticati i prisustvo neke sistemske bolesti kao što je dijabetes melitus (DM). Prikaz bolesnika. Prikazali smo apikalno zarastanje u predelu gornjeg centralnog sekutića, nakon retroopturacije sa TSC, kod bolesnika sa DM tipa 2 i prisutnom perifernom neuropatijom. Standardna resekcija korena gornjeg centralnog sekutića bila je urađena retropreparacijom ultrazvučnim nastavcima do dubine od 3 mm i retrogradnom opturacijom sa TSC. Zarastanje postoperativne regije bilo je u fiziološkim granicama. Bolesnik se, međutim, žalio na nedefinisan, tup bol u predelu operisane regije koji je verovatno bio povezan sa nedijagnostikovanom intraoralnom dijabetičnom perifernom neuropatijom, što je potvrđeno kliničkim nalazom. Zaključak. Iako TSC predstavlja pogodan materijal za retrogradnu opturaciju kanala korena zuba u lečenju hroničnih periradikularnih lezija, u proceni ishoda lečenja treba imati u vidu i moguće prisustvo perifernih manfestacija sistemskih bolesti kao što je DM tipa 2.

The local anaesthetic and haemodynamic parameters achieved by lidocaine with clonidine or epinephrine, administered for maxillary infiltration anaesthesia, were studied in 40 patients (American Society of Anesthesiologists, physical status 1) who underwent upper third molar surgery. All patients received 2 ml of 2% lidocaine with clonidine (15 mu g/ml; n = 20) or epinephrine (12.5 mu g/ml; n = 20) in a randomized, double-blind fashion. Vascular effects were evaluated on the isolated human infraorbital arteries. The parameters of maxillary infiltration anaesthsia produced by a combination of lidocaine + clonidine were similar to those obtained with lidocaine + epinephrine. In both groups, haemodynamic parameters exhibited similar variations, with the exception of a significant reduction in heart rate and systolic blood pressure in the lidocaine + clonidine group and significant increase in heart rate in the lidocaine + epinephrine group, 10 min after surgery. Clonidine (10(-7), 10(-6) and 10(-5) M) produced an endothelium-independent vasocontractile effect on the isolated human infraorbital arteries. The results of this study indicate for the first time in dental anaesthesia that the lidocaine + clonidine combination could be a useful and safe alternative to lidocaine + epinephrine for intraoral infiltration anaesthesia.

The admixture of clonidine or epinephrine to lidocaine for inferior alveolar nerve block was studied with regard to onset, duration, intensity of anaesthesia, postoperative analgesia, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), ST segment depression ≥1 mm and cardiac arrhythmias. Forty healthy patients (ASA I) received 2 ml 2% lidocaine with clonidine (15 μg/ml; n = 20) or epinephrine (12.5 μg/ml; n = 20) in a double-blind fashion for lower third molar surgery. Duration and intensity were not different between groups, while onset was significantly different by subjective evaluation. The need for postoperative pain medication was significantly lower in the clonidine group. There was a significant decrease in SBP and MAP in both groups 35 min after administration of anaesthesia compared with basal values, while DBP was significantly lower only in the clonidine group. There was no significant difference in SBP, DBP and MAP between groups. HR was significantly increased in the epinephrine group 5 min after administration of anaesthesia and during surgery compared with the clonidine group and with basal values. The presented data suggest that clonidine could be a useful and safe alternative to epinephrine for intraoral block anaesthesia.

Introduction: Vascular endothelial growth factor (VEGF) and bone morphogenetic protein 2 (BMP 2) are growth factors (GFs) identified within the dentine-pulp complex and involved into the cellular events connected to the pulp-healing response. It is well established that the expression of these GFs is increased in different tissues in diabetes mellitus. Because there are no data concerning the levels of VEGF and BMP 2 in human dental pulp, the aim of present study was to quantify VEGF and BMP 2 levels in intact dental pulp and dental pulp that underwent reactive dentinogenesis in healthy and diabetic human subjects. Methods: The study was conducted on 28 healthy and 28 subjects with controlled diabetes type II who underwent pulp extirpation as a part of prosthetic rehabilitation. Pulp were collected from intact teeth and teeth treated by indirect pulp capping. The levels of VEGF and BMP 2 were determined in the pulp tissue lysates with enzyme-linked immunosorbent assay. Results: The levels of VEGF and BMP 2 were significantly higher in intact teeth pulp of diabetic than in healthy subjects. The concentrations of these GFs were significantly lowered in teeth with indirect pulp capping both in healthy and diabetic persons. Furthermore, VEGF and BMP 2 levels were in strong positive correlation. Conclusions: Similar changes in the levels of VEGF and BMP 2 in intact and treated teeth of healthy and diabetic patients could be suggestive of associated roles of these GFs in responses of healthy and diabetic dental pulp. (J Endod 2012;38:764-768)

The main purpose of this study was to assess the clinical efficacy and haemodynamic effects of ropivacaine for infiltration anaesthesia in patients undergoing surgical removal of upper third molars. The safety profile of ropivacaine was also studied by investigating the maximal venous plasma concentration of ropivacaine and the reactivity to ropivacaine of isolated human infraorbital arteries. Ropivacaine in concentrations of 0.5, 0.75 and 1% achieved dose-dependent parameters of maxillary infiltration aneasthesia, clinically relevant in concentrations 0.75 and 1%. Postoperative needs for analgesics were observed in 67-100% of patients. Haemodynamic parameters were stable during surgery with significant changes occuring 10 min after surgery. After maxillary infiltration of 2.0 ml 1% ropivacaine, the maximum venous plasma concentration (Cmax) was 82+/-15 microg/l. On isolated human infraorbital artery, ropivacaine (10(-4)M) induced endothelium-independent contraction. This study suggests that 0.75 and 1% ropivacaine offers adequate and safe intraoperative analgesia but not successful postoperative pain control for the surgical removal of upper third molars.