Giuseppe Alessandro Scardina

Angiogenesis in Oral Lichen Planus: An In Vivo and Immunohistological Evaluation

Oral lichen planus (OLP) is an autoimmune disease with an inflammatory pathogenesis. The angiogenetic phenomenon is a mechanism at the base of the pathogenesis of chronic inflammatory processes. The aim of this research is to evaluate the angiogenetic phenomenon, comparing an in vitro method with an in vivo one. Thirty OLP patients and 30 healthy subjects were enrolled in the study. Immunohistochemical analysis of the vascular-endothelial growth factor (VEGF) and vascular-endothelial adhesion molecules were carried out by the means of primary antibodies and anti-CD34, anti-VEGF, anti-CD106 antigen (VCAM-1) and anti-CD54 antigen (ICAM-1). Capillary density and others capillaroscopic parameters were tested in vivo using oral videocapillaroscopy. The results reveal the presence of a significant angiogenesis in OLP patients through the immunoexpression of VEGF, CD34, CD106 and CD54 (pxa0<xa00.001). Capillaroscopic analysis demonstrates significant value for the following parameters: density, tortuosity, loop diameter, afferent and efferent capillary loop diameter. The in vivo and in vitro investigation in OLP reveals a significant angiogenesis.

Periodontal alteration of the microcirculation and hypercholesterolemia: a possible correlation?

Objective: We evaluated the morphological and parametric characteristics of the periodontal microcirculation in patients diagnosed as having hypercholesterolemia and high levels of low-density lipoprotein (LDL). Methods: Forty patients were recruited, 20 of whom were affected by hypercholesterolemia and 20 of whom were considered healthy. A videocapillaroscopic examination was carried out on the periodontal mucosa in the proximity of the frenulum (II, V sextant). Results: The difference between the parameters of the hypercholesterolemia group and the control group was evaluated with the Mann-Whitney U-test for non-parametric ordinal data; the level of significance being P < 0.05. The videocapillaroscopy documented extremely significant differences between the two groups, regarding the following parameters: total diameter of the loop (P = 0.0017), diameter of the afferent loops (P = 0.0004), diameter of the efferent loops (P = 0.00008) and periodontal density (P = 0.0001). Conclusions: The capillaroscopic examination revealed a morphological alteration of the periodontal microcirculation in patients with hypercholesterolemia, which is an expression of peripheral vascular phlogosis.

The effect of cigar smoking on the lingual microcirculation.

The aim of this study was to analyze the lingual microcirculation in vivo and to evaluate the effects on it of cigar smoking, using computerized videocapillaroscopy. Twenty-five healthy nonsmokers and 25 healthy smokers were examined. For each subject we evaluated the visibility, course, tortuosity, and any images characteristic of capillary loops, as well as the possible presence of microhemorrhages, the average caliber of the capillary loops, and the number of capillary loops visible per square millimeter. The investigation of the lingual mucosa revealed capillary loops with a course parallel to the surface. In smokers, capillary loops had a smaller caliber (P < 0.001) and there was a higher number of detectable capillary loops (P < 0.001). An important correlation between capillary tortuosity and cigar smoking (P < 0.001) was observed. Our research shows that chronic smoking induces significant changes in lingual capillary morphology, caliber, and number.

Periodontal Disease and Sjögren Syndrome: A Possible Correlation?

Sjögren syndrome (SS) is a chronic autoimmune rheumatic disease characterized by a progressive lymphocytic infiltration of exocrine glands, especially salivary and lachrymal ones, leading to xerostomia, parotid gland enlargement, and xerophthalmia. The aim of this study is to describe the capillaroscopic pattern of the interdental papilla in patients with SS and to evaluate a possible correlation with periodontal disease. Methods: A total of 25 patients affected by SS and 25 healthy controls were examined. The patients with conditions that compromise microcirculation, such as diabetes, hypertension, hyperlipidemia, or some pharmacological treatments, were not included in the study. All the patients were nonsmokers. Periodontal capillaroscopy has been used to investigate the features of microcirculation. Visibility, course, tortuosity, as well as the possible presence of microhemorrhage, the average caliber of the capillary loops, and the number of visible capillary loops per square millimeter were evaluated for each patient. Results: The results show evident alterations to the capillaries and a typical conformation of the interdental papilla microcirculation in patients with SS; it was possible to observe a reduced caliber of capillaries, as well as a greater number and tortuosity of capillary loops. Conclusion: This study shows that capillary alterations to patients with SS occur in gingival microcirculation.

Modifications of interdental papilla microcirculation: a possible cause of periodontal disease in Hashimoto's thyroiditis?

BACKGROUNDnHypothyroidism is defined by a decrease in thyroid hormone production and thyroid gland function. The aim of the present research has been to evaluate the morphologic interdental papilla microcirculation of patients suffering from Hashimoto thyroiditis (HT) and to evaluate a possible correlation with the associated periodontal disease.nnnMETHODSnFifteen healthy subjects and 15 patients suffering from HT were examined. The patients who showed conditions known to compromise microcirculation, such as diabetes, hypertension and pharmacological treatments, were not included in the group of healthy patients. All patients were non-smokers. Gingival capillaroscopy was used to investigate the characteristics of microcirculation. Visibility, course, tortuosity, the average caliber of the capillary loops and the number of visible capillary loops per square millimeter were evaluated for each patient.nnnRESULTSnAn interdental papilla vascular modification results in HT. In patients suffering from HT, it was possible to observe a reduced caliber of capillaries, as well as a greater number and tortuosity of capillary loops.nnnCONCLUSIONSnThis study shows that capillary alterations in patients suffering from HT occur in gingival microcirculation.

Oral microcirculation in post-menopause: a possible correlation with periodontitis

OBJECTIVESnThe reduction in the level of oestrogen, typical in menopause, has some effect on the health of the oral cavity. In fact, post-menopausal women present more severe periodontal disease than pre-menopausal women. Numerous factors can be held to be responsible for this increase, among which are the effects of oestrogens on the oral epithelium, on the salivary glands, on bone tissue and on the endothelium. Our double blind study aims to evaluate the possible variations in oral microcirculation in post-menopausal women.nnnMETHODSnTwenty-seven women in post-menopause (age: Mean ± SD: 57.3 ± 8.73) and 27 women in pre-menopause (age: Mean ± SD: 27.77 ± 3.56) were examined. Oral microcirculation was investigated using oral videocapillaroscopy.nnnRESULTSnThe study showed significant differences between cases and controls for the following parameters: decrease in diameter of loops (mean ± SD: 0.038 ± 0.008; 0.045 ± 0.005), increase in tortuosity (mean ± SD: 3.83 ± 1.13; 1.83 ± 1.06) in labial mucosa and decrease in density in periodontal mucosa (Mean ± SD: 28.86 ± 10.92; 89.62 ± 17.83).nnnCONCLUSIONnThe decrease in periodontal density may compromise the epithelium tropism, making it prone to inflammation. The tortuosity may indicate a greater permanence of inflammatory factors, increased in post-menopausal women.

Microvascular characteristics of the human interdental papilla.

The aim of this study was to observe the microcirculation characteristics of the human interdental papilla in healthy patients in vivo. Twenty healthy patients were examined. Capillaroscopy was used to investigate the characteristics of microcirculation of the human periodontal mucosa. Visibility, course, tortuosity, as well as the average caliber of the capillary loops and the number of visible capillary loops per square millimeter were evaluated for each patient. The investigation of gingival mucosa revealed capillary loops with a course both parallel and perpendicular to the surface. Our study has pointed out that capillaroscopy is a reliable method to study periodontal microcirculation in vivo. This method could be applied to the study of microcirculation in periodontal diseases. Future studies might evaluate whether microcirculation in that area is compromised or not during systemic pathologies involving peripheral microcirculation alterations.

A non-parametric segmentation methodology for oral videocapillaroscopic images

We aim to describe a new non-parametric methodology to support the clinician during the diagnostic process of oral videocapillaroscopy to evaluate peripheral microcirculation. Our methodology, mainly based on wavelet analysis and mathematical morphology to preprocess the images, segments them by minimizing the within-class luminosity variance of both capillaries and background. Experiments were carried out on a set of real microphotographs to validate this approach versus handmade segmentations provided by physicians. By using a leave-one-patient-out approach, we pointed out that our methodology is robust, according to precision-recall criteria (average precision and recall are equal to 0.924 and 0.923, respectively) and it acts as a physician in terms of the Jaccard index (mean and standard deviation equal to 0.858 and 0.064, respectively).

In vivo evaluation of the vascular pattern in oral peri-implant tissues.

INTRODUCTIONnThe vascularisation of the peri-implant tissue represents the key factor in obtaining a successful result in implantology, since an adequate vascular supply allows wound healing and the presence of numerous growth factors that promote osteogenesis. The aim of this study was to analyse in vivo the vascular pattern of the peri-implant mucosa in subjects that received implant treatment.nnnMATERIALS AND METHODSnIn the study 22 subjects were examined, 11 of whom (test group) received dental implants (Straumann Dental Implant System) while 11 were in the control group; the analysis was performed in the peri-implant masticatory mucosa. The evaluation of the microcirculation was performed in vivo using the optical probe videocapillaroscopy technique equipped with 200× lenses. The following parameters were recorded: capillary density, vascular areas, microhaemorrhages and angioarchitecture.nnnRESULTSnThe values indicating the capillary density were significantly different in the test group compared to the control group, indicating an angiogenic process taking place in vivo. In the test group the capillary loops were arranged parallel (30%) as well as perpendicular to the surface; in contrast, in the control group the gingival margin was always perpendicular to the surface (100%).nnnCONCLUSIONSnThe peri-implant vascular pattern exhibits special characteristics that differ both in morphology and density from the gingival one.

Periodontal microcirculation in diabetics: An in vivo non-invasive analysis by means of videocapillaroscopy

Summary Background Diabetes mellitus is today considered a society-wide disease of a chronic/degenerative nature. Among the secondary effects of diabetes, the one that interests the dental surgeon most is diabetic parodontopathy. The aim of this study was to underline and objectify microcirculatory variations at a periodontal mucous level in type 2 diabetics. Material/Methods The study enrolled 80 subjects: 40 subjects with a diagnosis of diabetes mellitus type II (18 males and 22 females, between 44 and 85 years of age); and 40 healthy subjects (17 males and 23 females, between 44 and 78 years of age). All the subjects, both diabetic and healthy, were submitted to a videocapillaroscopic examination of the mucosa of the oral cavity. Results The measurements concerning the density (expressed in the number of loops/mm2) of the capillary loops presented differences between the healthy subjects and the diabetic subjects. The average periodontal capillary density (DC-P) was clearly superior in diabetic subjects (35.62±10.40 n°loop/mm2) compared to healthy subjects (17.55±3.88 n°loop/mm2). The statistical analysis was performed by means of the Mann Whitney test. The value of P (p=0.000000986), well below the level of significance, demonstrates the high significance of the results obtained. Conclusions The increase in capillary density could suggest the presence of active inflammatory phenomena or, more probably, a tendency to a greater susceptibility to inflammatory phenomena. Ultimately, this study shows that there is some peripheral damage to microcirculation at the masticatory mucous level in diabetic subjects and that such alterations can be instrumentally objectified and quantified through the videocapillaroscopic method.