Aleksandar Jakovljevic

Accuracy of Cameriere's third molar maturity index in assessing legal adulthood on Serbian population

At the moment, a large number of asylum seekers from the Middle East are passing through Serbia. Most of them do not have identification documents. Also, the past wars in the Balkan region have left many unidentified victims and missing persons. From a legal point of view, it is crucial to determine whether a person is a minor or an adult (≥18 years of age). In recent years, methods based on the third molar development have been used for this purpose. The present article aims to verify the third molar maturity index (I3M) based on the correlation between the chronological age and normalized measures of the open apices and height of the third mandibular molar. The sample consisted of 598 panoramic radiographs (290 males and 299 females) from 13 to 24 years of age. The cut-off value of I3M=0.08 was used to discriminate adults and minors. The results demonstrated high sensitivity (0.96, 0.86) and specificity (0.94, 0.98) in males and females, respectively. The proportion of correctly classified individuals was 0.95 in males and 0.91 in females. In conclusion, the suggested value of I3M=0.08 can be used on Serbian population with high accuracy.

Human cytomegalovirus and Epstein-Barr virus in etiopathogenesis of apical periodontitis: a systematic review.

INTRODUCTION During the last decade, a hypothesis has been established that human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) may be implicated in the pathogenesis of apical periodontitis. The aim of this review was to analyze the available evidence that indicates that HCMV and EBV can actually contribute to the pathogenesis of periapical lesions and to answer the following focused question: is there a relationship between HCMV and EBV DNA and/or RNA detection and the clinical features of human periapical lesions? METHODS The literature search covered MEDLINE, Science Citation Index Expanded (SCIexpanded), Scopus, and The Cochrane Library database. Quantitative statistical analysis was performed on the pooled data of HCMV and EBV messenger RNA transcripts in tissues of symptomatic and asymptomatic periapical lesions. RESULTS The electronic database search yielded 48 hits from PubMed, 197 hits from Scopus, 40 hits from Web of Science, and 1 from the Cochrane Library. Seventeen cross-sectional studies have been included in the final review. The pooled results from quantitative systematic method analysis showed no statistically significant relationship between the presence of HCMV and EBV messenger RNA transcripts (P = .083 and P = .306, respectively) and the clinical features of apical periodontitis. CONCLUSIONS The findings of HCMV and EBV transcripts in apical periodontitis were controversial among the included studies. Herpesviruses were common in symptomatic and large-size periapical lesions, but such results failed to reach statistical significance. Further studies, including those based on an experimental animal model, should provide more data on herpesviruses as a factor in the pathogenesis of periapical inflammation.

Human Cytomegalovirus and Epstein-Barr Virus Genotypes in Apical Periodontitis Lesions

INTRODUCTION Different genotypes of human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) possess specific pathogenic abilities because of various interactions with the hosts immune system and differences in cell tropism. The aim of this study was to determine the distribution of HCMV and EBV genotypes in apical periodontitis lesions in relation to their clinical and histopathologic features. METHODS One hundred samples of apical periodontitis lesions and 25 control samples (healthy pulp tissue) were collected. The presence of HCMV glycoprotein B (gB) and EBV nuclear antigen-2 genotypes was analyzed by nested polymerase chain reaction and restriction fragment length polymorphisms analysis. RESULTS EBV and HCMV were detected in apical periodontitis lesions at significantly higher frequencies than in healthy pulp controls (P = .020 and P = .020, respectively). HCMV gB type II was significantly more frequent compared with gB type I in the examined groups (P = .036). No HCMV gB type III or IV products were found. In both periapical lesions and controls, EBV-1 occurred more often compared with EBV-2 (P = .001). Dual EBV and HCMV coinfection was more frequently detected in large-size periapical lesions (P = .038). CONCLUSIONS Both HCMV and EBV are associated with inflammatory processes of periapical bone destruction. HCMV gB type II and EBV-1 are the most prevalent genotypes in apical periodontitis lesions.

Pro-inflammatory cytokine levels in human apical periodontitis: Correlation with clinical and histological findings

This study aimed to compare the levels of tumour necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β) and interleukin-6 (IL-6) between apical periodontitis lesions with different clinical and histological features. Based on clinical data and history of disease, 100 human apical periodontitis lesions were categorised as either asymptomatic or symptomatic lesions. According to histological examination, lesions were divided into periapical granulomas and radicular cysts. Pulp tissues of 25 impacted wisdom teeth were used as controls. Homogenised tissue samples were centrifuged and supernatants were used for the determination of cytokine levels by enzyme-linked immunosorbent assay. Significantly higher levels of IL-1β and IL-6 were found in symptomatic lesions compared with asymptomatic lesions and control tissues (P < 0.001, P < 0.001, respectively). The concentration of IL-1β was significantly higher in radicular cysts compared with periapical granulomas (P = 0.003). Symptomatic lesions, as judged by high local production of IL-1β and IL-6, represent an immunologically active stage of the disease.

Epstein-Barr virus infection induces bone resorption in apical periodontitis via increased production of reactive oxygen species

Chronic inflammatory processes in periapical tissues caused by etiological agents of endodontic origin lead to apical periodontitis. Apart from bacteria, two herpesviruses, Epstein-Barr virus (EBV) and Human cytomegalovirus (HCMV) are recognized as putative pathogens in apical periodontitis. Although previous reports suggest the involvement of EBV in the pathogenesis of apical periodontitis, its exact role in periapical bone resorption has not yet been fully elucidated. We hypothesize that EBV infection in apical periodontitis is capable of inducing periapical bone resorption via stimulation of reactive oxygen species (ROS) overproduction. Increased levels of ROS induce expression of receptor activator of nuclear factor kappa B (NF-κB) ligand (RANKL). RANKL binding to receptor activator of nuclear factor κB (RANK) present on the surface of preosteoclasts induces their maturation and activation which consequently leads to bone resorption. The potential benefit of antiviral and antioxidant-based therapies in periapical bone resorption treatment remains to be assessed.

Herpesviruses in Periapical Pathoses: An Updated Systematic Review

Apical periodontitis represents a chronic inflammation and destruction of periradicu‐ lar tissue caused by polymicrobial infection of endodontic origin. The aim of this systematic review was to make an update on findings related to Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) presence in periapical pathoses and to correlate these findings with clinical, histopathological and radiographic features of periapical lesions. Methods were based on the preferred reporting items for systemat‐ ic reviews and meta-analyses (PRISMA) statement. A search was performed using PubMed, Web of Science and SCOPUS. Search key words included the following medical subjects heading terms: (periapical disease OR apical periodontitis OR periapical lesions OR periapical abscess) AND (viruses OR herpesvir*). A manual search involved references from articles retrieved for possible inclusion. The search, evalua‐ tion, and critical appraisal of articles were performed by two independent judges. Collected data were analyzed using the measures of descriptive statistics. The final review has included twenty nine articles related to herpesviral presence periapical pathoses. Qualitative analysis indicated that EBV HCMV, and HHV-8 were the most prevalent species in periapical pathoses. Our findings suggest that there is wide variety of herpesviruses detection rates in periapical pathoses in relation to their clinical, histopathological and radiographic features.

The Role of Varicella Zoster Virus in the Development of Periapical Pathoses and Root Resorption: A Systematic Review

Introduction Varicella zoster virus (VZV) and subsequent herpes zoster (HZ) infection have been proposed as a causative agent of periapical pathoses and root resorption. This review aimed to identify, synthesize, and present a critical analysis of the available data on the association among VZV, subsequent HZ infection, and the development of periapical pathoses and root resorption and to analyze the level of evidence of available studies. Methods The literature search covered MEDLINE, Science Citation Index Expanded, and Scopus. A qualitative critical appraisal of the included articles was performed. Results The electronic database search yielded 66 hits from PubMed, 73 hits from Web of Science, and 107 from Scopus. Seven case reports and 3 cross‐sectional studies were included in the final review. When summarized, in 7 patients with a history of a previous HZ attack and with no other apparent cause, 23 teeth were diagnosed with apical periodontitis, 8 teeth with internal and 1 tooth with external root resorption. The cross‐sectional studies investigated the presence of VZV DNA in samples of acute apical abscess. The VZV DNA was found only in 2 of 65 samples. Conclusions All studies included in this systematic review had a low level of evidence (4 and 5). Still, the potential role of VZV in the etiopathogenesis of periapical pathoses and root resorption cannot be ruled out. Future investigations should be directed toward the analysis of VZV pathologic effects on pulp blood vessels, which might cause local ischemia and tissue necrosis. HighlightsThe literature search covered MEDLINE, Science Citation Index Expanded, and Scopus.Seven case reports and 3 cross‐sectional studies were included in final review.Only 1 of 7 case reports comprehensively analyzed the association among clinical manifestations of a previous HZ attack, the detection of VZV DNA, and the presence of apical periodontitis and root resorption.All available and included studies in this systematic review had a low level of evidence (4 and 5).A potential role of VZV in the etiopathogenesis of periapical pathoses and root resorption cannot be ruled out.

Radiographic assessment of lower third molar eruption in different anteroposterior skeletal patterns and age-related groups

OBJECTIVE To analyze radiographic predictors for lower third molar eruption among subjects with different anteroposterior skeletal relations and of different age groups. MATERIALS AND METHODS In total, 300 lower third molars were recorded on diagnostic digital orthopantomograms (DPTs) and lateral cephalograms (LCs). The radiographs were grouped according to sagittal intermaxillary angle (ANB), subject age, and level of lower third molar eruption. The DPT was used to analyze retromolar space, mesiodistal crown width, space/width ratio, third and second molar angulation (α, γ), third molar inclination (β), and gonion angle. The LC was used to determine ANB, angles of maxillar and mandibular prognathism (SNA, SNB), mandibular plane angle (SN/MP), and mandibular lengths. A logistic regression model was created using the statistically significant predictors. RESULTS The logistic regression analysis revealed a statistically significant impact of β angle and distance between gonion and gnathion (Go-Gn) on the level of lower third molar eruption (P < .001 and P < .015, respectively). The retromolar space was significantly increased in the adult subgroup for all skeletal classes. The lower third molar impaction rate was significantly higher in the adult subgroup with the Class II (62.3%) compared with Class III subjects (31.7%; P < .013). CONCLUSION The most favorable values of linear and angular predictors of mandibular third molar eruption were measured in Class III subjects. For valid estimation of mandibular third molar eruption, certain linear and angular measures (β angle, Go-Gn), as well as the size of the retromolar space, need to be considered.

Herpesviral Infection in Periapical Periodontitis

Purpose of ReviewThis review describes the most recent findings on herpesviral infections and offers current concepts of herpesviral role in the pathogenesis of periapical periodontitis.Recent FindingsThirty articles reported data on herpesviral infection in periapical periodontitis. Epstein-Barr virus and human cytomegalovirus are the most frequently detected herpesviruses in periapical samples. The main hypothesis postulates a bidirectional herpesviral-bacterial relationship in the etiopathogenesis of periapical periodontitis. A high heterogeneity of herpesviruses incidence was registered within the studies, in part, due to various methodological approaches used in laboratory testing, different inclusion criteria, study design, seroprevalence of herpesviruses, and sociodemographic characteristics of investigated populations.SummaryHerpesviruses have been shown to potentially impair local host defense in periapical tissue. Although it has been demonstrated that endodontic pathogenic bacteria are able to reactivate herpesviruses, further, in vitro studies should provide more data on herpesviruses as a factor in the pathogenesis of the periapical pathoses. It is, therefore, necessary to investigate potential benefits of antiviral therapy in well-designed controlled longitudinal studies.

The characteristics of craniofacial and cervicovertebral morphology in different genetic syndromes – a literature review and three case reports

Craniofacial and cervicovertebral anomalies can occur primarily as a result of alterations in the embryonic development or secondary after birth as a result of pathologic processes or through trauma. 1 ABSTRACT Introduction: Patients with genetic syndromes were characterized by variety of skeletal craniofacial and cervicovertebral morphology. Skeletal anomalies are recognized concomitants of the various genetic syndromes. The aim of the study was to review the current literature on this topic and to present the characteristics of craniofacial and cervicovertebral morphology and subsequent anomalies in three patients with Crouzon syndrome, Treacher Collins syndrome and cleidocranial dysplasia. Materials and methods: A comprehensive electronic search was performed using PubMed via Medline, Web of Science and SCOPUS. A manual search involved references form articles retrieved for possible inclusion. There were no restrictions as to date of publication, study design or language. The search, evaluation of relevant articles, and their critical appraisal were performed by two independent judges. Discrepancies between reviewers were resolved through a consensus with a third party. Case reports: Additionally, this paper presents a radiographic analysis of craniofacial and cervicovertebral morphology in patients with cleidocranial dysplasia, Crouzon, and Treacher Collins syndromes. The most characteristic findings of cervicovertebral morphology were the presence of cervical spine fusions in all three patients. The intervertebral fusions in patients with Crouzon and Treacher Collins syndromes have been characterized with “block vertebrae”. Cervicovertebral complex of the patient with cleidocranial dysplasia is characterized by delayed mineralization of vertebral bodies (C1–C7). Results: Although craniofacial and cervicovertebral anomalies in presented syndromes have different phenotype expression, the vast majority of cases are caused by mutations in specific, syndrome-related genes (FGFR2, FGFR3, RUNX2, TCOF1, POLR1C, POLR1D). Craniofacial anomalies, that include changes in development of hard and soft tissues, were considered as traditional concomitant of presented syndromes. Apart from these changes, cervicovertebral region could also be affected. Recent reports show different changes in vertebral structure (delayed mineralization) and unphysiological relations (cervical spine fusions). Conclusion: The limitation of cervical range of motion resulting from these anomalies may have clinical significance on multidisciplinary management approach in these patients. Recent progress in dentistry resulted in better diagnostic and therapeutic options and outcomes for individuals with genetic syndromes.