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ABSTRACT REZUMAT
The exfoliative cytology is a non-invasive technique Citologia exfoliativă este o tehnică noninvazivă utilizată în
used for study of epithelial specialization changes of studiul modificărilor diferenţierii epiteliale ale suprafeţelor
mucosal surfaces. Aim of the study: The aim of our study mucozale. Scop: Stabilirea modificărilor mucoasei orale la
was to estabilish the changes of oral mucosa of partially subiecţii edentaţi protezaţi parţial amovibil şi evaluarea
edentulous patients treated with removable dentures and modificărilor citologice în dinamica procesului de adaptare.
the evaluation of cytological changes in the dynamics of Material şi metodă: Pacienţii selectaţi au fost distribuiţi în
adaptation process. Material and method: The selected două loturi de studiu, în funcţie de tipul protezării. Pacienţii au
patients were divided in two groups, according to denture fost investigaţi clinic şi paraclinic prin examen citologic,
support. The patients were investigated clinical and stabilindu-se în dinamică modificările mucoasei, cu stabilirea
paraclinical using cytological exam used to estabilish the indicilor de keratinizare supuşi interpretării statistice.
changes of mucosa in dynamics. Statistical analyse was Rezultate: Se remarcă prezenţa diferitelor forme clinice de
made for the interpretation of keratinization indices. patologie paraprotetică a mucoasei. Studiul citologic ce
Results: The clinical study showed the presence of urmăreşte adaptarea în dinamică a protezelor parţial amovibile
different pathological forms of mucosa. The cytological indică o scădere a indicelui de keratinizare în primele zile, cu
exam indicated a descrease of keratinization index in the revenire spre normalitate pe măsura adaptării cu protezele
first days of prosthetic treatment, with reversion to mobile. Concluzii: Studiul mucoasei orale la pacienţii edentaţi
normality, according as the adaptation with the dentures. parţial şi protezaţi constituie un argument de apreciere a
Conclusions: The study of oral mucosa represents an calităţii protezării amovibile, fapt argumentat şi de metodele
important argument for the apreciation of the quality of statistice utilizate.
the removable dentures. Cuvinte cheie: MUCOASA ORALĂ, PROTEZE
Key words: ORAL MUCOSA, REMOVABLE AMOVIBILE, KERATINIZARE
DENTURES, KERATINIZATION.
INTRODUCTION INTRODUCERE
The oral mucosa has an important place in the Mucoasa orală ocupă un loc aparte în patologia
pathology of stomathognatic system, due of sistemului stomatognat, având o structură şi o
charateristic structure and development. Also, the dezvoltare caracteristică. Prin funcţiile şi solicitările
oral mucosa has an unstable equilibrum that can be la care este supusă continuu, se află într-un
easily influnced by the factors who action at this echilibru labil, ce poate fi uşor influenţat de
level. numeroşi factori ce acţionează la acest nivel. Natura
The dynamic nature of oral cavity submits the dinamică a cavităţii orale supune mucoasa orală la
oral mucosa to friction and compresion in the fricţiune şi compresiune în timpul funcţionalităţii.
moment of functionality. The epithelial tissues are Ţesuturile epiteliale sunt expuse insultelor
exposed to mechanical, thermical, microbian and mecanice, termice, microbiene şi chimico-toxice,
chemico-toxic injuries, the cells being vulnaralable celulele fiind vulnerabile distrucţiei care consecutiv
to damage that consecutive induces the epithelial mandatează regenerarea epitelială continuă. (Al-
differentiation (Al-Hashimi, 2004). Hashimi, 2004)
The exfoliative cytology is a non-invasive Citologia exfoliativă este o tehnică noninvazivă
technique used for study of epithelial specialization utilizată în studiul modificărilor diferenţierii
changes of mucosal surfaces. Also, it is an epiteliale ale suprafeţelor mucozale. De asemenea
important method in the monitorization of este o metodă valoroasă în monitorizarea şi
mucosal lesions, being an excellent auxiliary urmărirea leziunilor mucozale fiind un test
diagnosis test ( Cowpe JG, 1988; Ravi M, 2006). diagnostic auxiliar excelent ( Cowpe JG, 1988; Ravi
M, 2006)
THE AIM OF THE STUDY
The aim of our study was to estabilish the SCOPUL STUDIULUI
changes of oral mucosa of partially edentulous Stabilirea modificărilor mucoasei orale la
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ORAL BIOLOGY / BIOLOGIE ORALĂ
patients treated with removable dentures and the subiecţii edentaţi protezaţi parţial amovibil şi
evaluation of cytological changes in the dynamics evaluarea modificărilor citologice în dinamica
of adaptation process. procesului de adaptare.
MEDICINA STOMATOLOGICĂ, vol. 10, nr. 1, 2006 / JOURNAL OF ROMANIAN DENTISTRY, vol. 10, issue 1, 2006 7
ORAL BIOLOGY / BIOLOGIE ORALĂ
82 82
82 82
81 80,71 81 80,71
80 80 80 80
80 80
79,29 79,29
79 79
79 79
78,29 78,29
78 78
77,43 77,43
77 77
sinker0 sinker0
77 77 Outliers
Outliers
sindker1 sindker1
Outliers 76
Outliers
76
76 sinker2 76 sinker2
Outliers Outliers
sindker3 sindker3
Outliers Outliers
75 75
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ORAL BIOLOGY / BIOLOGIE ORALĂ
average calculating keratinization index were Ceea ce ne interesează este dacă diferenţele
statistic significant, even if the results obtained dintre mediile indicilor de keratinizare sunt
from prosthetic treatment with acrylic dentures and semnificative statistic, adică dacă rezultatele
dentures supported by mucosa and tooth borne are obţinute în urma protezării acrilice şi scheletate
ramdomly or are the clear effect of the prosthetic sunt aleatorii sau sunt chiar efectul protezării cu
treatment with dentures supported by mucosa and sprijin muco-osos sau mixt.
bone or mucosa and tooth borne.
Testul t pentru eşantioane perechi
Paired Differences
95% Confidence
Interval of the
Std. Error Difference
Mean Std. Deviation Mean Lower Upper t Sig. (2-tailed)
Pair indice de keratinizare -
1 indice de keratinizare 4.00 .784 .210 3.55 4.45 19.079 .000
dupa o luna
Pair indice de keratinizare -
2 indice de keratinizare 6.17 2.918 .842 4.31 8.02 7.321 .000
dupa 7 zile
Pair indice de keratinizare
3 dupa 21 zile - indice de -1.17 .389 .112 -1.41 -.92 -10.383 .000
keratinizare dupa 7 zile
Pair indice de keratinizare
4 dupa 21 zile - indice de -3.50 2.316 .669 -4.97 -2.03 -5.235 .000
keratinizare dupa o luna
Table I. Paired t- test for keratinization index – prosthetic treatment with dentures suppored by mucosa and bone
Testul t pentru eşantiane perechi – protezare parţial amovibilă cu sprijin muco-osos
Testul t pentru esantioane perechi
Paired Differences
95% Confidence
Interval of the
Std. Error Difference
Mean Std. Deviation Mean Lower Upper t df Sig. (2-tailed)
Pair indice de keratinizare
1 înainte de protezare -
1.43 .514 .137 1.13 1.73 10.408 13 .000
indice de keratinizare la
o lună de la protezare
Pair indice de keratinizare
2 înainte de protezare -
2.43 .938 .251 1.89 2.97 9.691 13 .000
indice de keratinizare la
7 zile de la protezare
Pair indice de keratinizare la
3 21 zile de la protezare -
-.86 .363 .097 -1.07 -.65 -8.832 13 .000
indice de keratinizare la
7 zile de la protezare
Pair indice de keratinizare la
4 21 zile de la protezare -
-1.86 1.027 .275 -2.45 -1.26 -6.765 13 .000
indice de keratinizare la
o lună de la protezare
Table II. Paired t- test for keratinization index – prosthetic treatment with dentures suppored by mucosa and tooth
borne
Testul t pentru eşantiane perechi – protezare parţial amovibilă cu sprijin mixt
The statistical analyse of the variables (Table I) În urma analizei statistice a datelor (Tabel I), s-a
showed that the mean of keratinization index constatat că media indicelui înainte de protezarea
before the treatment with acrylic dentures (M = cu aparate gnato-protetice parţial amovibile cu
78.33) and the mean of the index after 1 month (M sprijin muco-osos (M = 78,33) şi media indicelui
= 72.44) was significant different (t =19.079, df17, după o lună (M = 72,44) diferă semnificativ (t
p = 0.000).Also, we observed statistical significant =19,079, df17, p = 0,000). Diferenţe statistice
differences before and after 7 days of the semnificative ale indicelui de keratinizare s-au
prosthetic treatment with dentures supported by constatat înainte de protezare şi la 7 zile de la
mucosa and bone (p < 0.05). The statistical analyse protezarea parţial amovibilă acrilică (p < 0,05). De
showed statistical significant differences between asemenea, analiza statistică a evidenţiat diferenţe
the keratinization index after 7 days –21 days of the semnificative între indicele de keratinizare la 7 zile
prosthetic therapy (p < 0.05). The keratinization de la protezare - 21 de zile (p < 0,05). Indice de
index 21 days-1 month was statistical significant (p keratinizare după 21 de zile – indice de keratinizare
< 0.05). după o lună, diferenţele sunt statistic semnificative
(p < 0,05).
MEDICINA STOMATOLOGICĂ, vol. 10, nr. 1, 2006 / JOURNAL OF ROMANIAN DENTISTRY, vol. 10, issue 1, 2006 9
ORAL BIOLOGY / BIOLOGIE ORALĂ
Table III. Independent samples t-test – keratinization index for prosthetic treatment with acrylic dentures and
dentures supported by mucosa and tooth borne
Testul t pentru eşantioane independente –indice de keratinizare pentru protezarea acrilică şi scheletată
DISSCUTIONS DISCUŢII
The stomathognatic system has like any Sistemul stomatognat, dispune ca orice parte
component of human organism a great capacity of componentă a organismului uman de o capacitate
adaptation to the new ones situatitions created by mare de adaptare la noile situaţii create de
prosthetic treatment. protezare. Fenomenul de adaptare sau
The occurrence of adaptation achieved by automenţinere, realizat prin autostimulare şi
autostimulation and autoreglation may accept or autoreglare, poate să accepte sau să elimine o serie
eliminate the adverse stimulants induced by de excitanţi nefavorabili determinaţi de protezarea
removable partial dentures. parţial amovibilă.
In the short time, 7 - 21 days after the La scurt timp de la protezare 7 - 21 de zile, se
prosthetic treatmen, it is observed an important observă o abundentă descuamare a mucoasei orale,
exfoliation of palatal mucosa. This process can be explicată prin tulburarea echilibrului biologic al
explained by the disturbance of biologic equilibrum cavităţii bucale. Prin integrarea biologică a aparatului
of oral cavity. The exfoliation of oral mucosa gnato-protetic parţial amovibil şi restabilirea funcţiilor
descreases, approching to normal, by reason of sistemului stomatognat, descuamarea descreşte
biological integration of removable partial dentures apropiiindu-se de normalitate. Reducerea în grosime a
and rehabilitation of functions of stomathognatic epiteliului mucoasei orale subjacente protezelor parţial
system. The deascrease of thickness of oral amovibile, indică faptul că acesta suferă o serie de
epithelium indicated that the epithelium suffered modificări adaptative în încercarea de a se uniformiza.
some adaptational changes in the trial to be Sub acţiunea aparatelor gnato-protetice amovibile,
uniformly. Under the action of removable partial gradul de keratinizare se reduce, stratul cornos al
dentures, the degree of keratinization descreases, epiteliului devenind mai subţire. În general se
the stratum corneum of epithelium being thicker. consideră că la subiecţii edentaţi parţial sau total,
In general, it is consider that in the subjects with procentul de celule keratinizate este mai mare înainte
partially or totally edentoulness, the percentage of de protezare, datorită traumatismului masticator direct
keratinizated cells is greater, befor the prosthetic exercitat asupra mucoasei orale şi urmare a reacţiei de
treatment, because the direct trauma exert on oral apărare a organismului la excitanţii exogeni (Ursache,
mucosa and the reaction of defence to external 1996). După protezare, procentul de keratinizare
stimulants (Ursache, 1996). After the prosthetic scade treptat, pe măsura adaptării pacientului la
treatment, the keratinization degree progressively aparatul gnato-protetic parţial amovibil, adaptării
descreases by reason of patient’s adaptation, protezei pe câmpul protetic, în raport cu reactivitatea
denture’s adaptation on the prosthetic field related individuală a fiecărui subiect şi în funcţie de leziunile
with individual reactivity of the subject and related de decubit care conduc la procesele mucozale
with decubitus lesions that lead to inflammatory inflamatorii (Fig 3).
mucosal process (Fig. 3). Un aparat gnato-protetic necorespunzător
The existence of an improper removable adaptat şi instabil la ţesuturile de susţinere,
denture represents an adeverse stimulus for the reprezintă un stimul nociv pentru apariţia
appearance of inflammatory process and proceselor inflamatorii şi parakeratozei.
parakeratinization. The movements of the Microbasculările protezelor, în special a celor cu
dentures, especially of those supported by mucosa sprijin muco-osos care tratează edentaţii parţiale
and bones are factors that change the keratinization întinse uni şi biterminale sunt factori care modifică
process. Contrary, a removable partial denture with procesul de keratinizare. În opoziţie, o proteză cu o
a good retention and stability, a balanced occlusion, bună retenţie şi stabilitate, echilibrată corect
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ORAL BIOLOGY / BIOLOGIE ORALĂ
stimulates the keratinization of mucosa (Fig. 4). ocluzal, stimulează keratinizarea mucoasei (Fig. 4).
Fig. 3 Fig. 4
The exfoliative cytology showed the presence of Citologia exfoliativă a evidenţiat prezenţa
unkeratinizated cells with keratohyalin granules, celulelor nekeratinizate cu granule de keratină,
parakeratosis, keratinizated cells without nucleus parakeratoză, celule keratinizate fără nucleu şi
(Fig. 5). Also, we observed the presence of scuame de keratină (Fig. 5). De asemenea s-a
alterated PMN and cells with parakeratosis (Fig. 6) observat prezenţa de celule polimofo-nucleate
The results of the present study, showed that after alterate şi celule cu parakeratoză (Fig. 6).
the correction of dentures and the disappearence În urma rezultatelor studiului de faţă, s-a
of inflammatory lesions, the keratinization index observat că după efectuarea retuşurilor şi dispariţia
begin to increase. fenomenelor inflamatorii induse de proteze,
indicele de keratinizare a început să crească.
MEDICINA STOMATOLOGICĂ, vol. 10, nr. 1, 2006 / JOURNAL OF ROMANIAN DENTISTRY, vol. 10, issue 1, 2006 11
ORAL BIOLOGY / BIOLOGIE ORALĂ
BIBLIOGRAPHY
1. Al-Hashimi I, Williams MI. Biology of oral mucosa. 3. Ravi M, Gupta A, Singh M, Ibrahim R. Application of
Compendium 25(10) suppl.2; 2004:4-7 cytology and molecular biology in diagnosing premalignant
2. Cowpe JG, Longmore RB, Green MW. Quantitative or malignant oral lesions.Mol Cancer 2006; 5:11.
exfoliative cytology of abnormal oral mucosal smears. 4. Ursache M. Stomatopatiile paraprotetice. Ed. Ankarom,
Journal of the Royal Society of Medicine 1988; 81: 509-513. Iasi, 1996
ACTUALITĂŢI / NEWS
THE ABILITY OF THIOUREA TO SCAVENGE HYDROGEN PEROXIDE AND HYDROXYL RADICALS DURING
THE INTRA-CORONAL BLEACHING OF BLOODSTAINED ROOT-FILLED TEETH
Background : Hydrogen peroxide, an agent used in the intra-coronal bleaching of root-filled teeth for over a century, has been
shown to diffuse from the pulp chamber to the outer root surface. Furthermore, it has been demonstrated that destructive hydroxyl
radicals, the by-products of the bleaching process, have been detected on the external root surface. The control of such diffusion may be of
importance in minimizing the risk of invasive cervical resorption (ICR) which has been linked to intra-coronal bleaching of discoloured
root-filled teeth using hydrogen peroxide. The aims of the present in vitro study are to quantify the diffusion of hydrogen peroxide and
hydroxyl radicals to the outer root surface following intra-coronal bleaching, and to evaluate the ability of thiourea incorporated into the
bleaching protocol to scavenge residual hydrogen peroxide and hydroxyl radicals.
Methods : Thirty-five single rooted premolar teeth with intact cementum at the cemento-enamel junction were used in this project.
Thirty teeth were stained with red blood cells and root-filled with gutta-percha and AH26. The five unstained teeth were root-filled and
constituted a negative control (Group 1). The stained teeth were divided equally into the following experimental groups and subjected to
various intra-coronal bleaching regimes: Group 2 – ‘walking bleach’ with 20µl 30 per cent w/w hydrogen peroxide; Group 3 – 20µl
30 per cent w/w hydrogen peroxide and thermocatalytically activated; Group 4 – 20µl acidified thiourea; Group 5 – 20µl acidified
thiourea and 20µl 30 per cent w/w hydrogen peroxide; Group 6 – 20µl acidified thiourea and 20µl one per cent sodium hypochlorite;
Group 7 – 20µl acidified thiourea, 20µl one per cent sodium hypochlorite and 20µl 30 per cent w/w hydrogen peroxide. The reaction
products of the bleaching process were quantified at the outer root surface using high performance liquid chromatography and
electrochemical detection (HPLC-ECD).
Results : Results showed that hydrogen peroxide used alone in Groups 2 and 3 was able to be detected at the outer root surface in
100 per cent of the samples, and that the presence of the hydroxyl radical generated in both groups was detected in equal amounts
(P<0.05). When thiourea was incorporated into the bleaching protocols in Groups 5–7, it was shown to scavenge both hydrogen
peroxide and hydroxyl radicals to a significant degree (P<0.05).
Conclusions : Acidulated thiourea is an effective scavenger of residual hydrogen peroxide and hydroxyl radicals generated during
the intra-coronal bleaching of bloodstained root-filled teeth.
Key words : Thiourea, hydrogen peroxide, hydroxyl radicals, intra-coronal bleaching.
Abbreviations and acronyms : ICR = invasive cervical resorption; HPLC = high performance liquid chromatography;
ECD = electrochemical detection; 2,5-DHB = 2,5- dihydroxybenzoic acid; 2,3-DHB = 2,3-dihydroxybenzoic acid; EDTA =
ethylenediaminetetracetic acid; NaOCl = sodium hypochlorite; 3,4-DHB = 3,4-dihydroxybenzoic acid; CEJ = cemento-enamel
junction.
(Australian Dental Journal 2006;51:(2):146-152)
Ioana Rudnic
12