José Vicente Bagán Sebastián

Expression of cytokeratins in epithelialized periapical lesions

OBJECTIVE This study attempted to clarify whether differential immunocytokeratin expression occurs in cystic and epithelialized noncystic lesions. STUDY DESIGN From January 2003 to June 2004, periapical surgery was carried out on 70 teeth, collecting 70 histologic samples. Serial sections of original histologic slices were prepared for immunostaining. The antibodies used were against cytokeratins CK7, AE1, AE3, AE1-3, and CAM52. The intensity of staining was evaluated as follows: 0 = no cells stained; 1 = weak staining (11%-25%); 2 = moderate staining (26%-75%); and 3 = intense staining (>or=76%). RESULTS Ten epithelized granulomas and 6 cysts were included. Intense staining was seen for AE1 and AE1-3 in the 2 types of lesion; staining with AE3 was moderate for epithelized granulomas and cysts. CK7 demonstrated a light reactivity in the outermost epithelial layer. CAM52 showed weak staining for the epithelized granuloma and moderate for the cyst. CONCLUSIONS Cysts and epithelized granulomas presented the same cytokeratin expression, though with marked differences in distribution and degree of staining of cytokeratins. This immunochemical technique is interesting for the determination of the histologic type and the prognosis, but may not be clinically practicable.

Apixaban and oral implications.

Background Thrombotic disorders remain a leading cause of death in the Western world, and in this regard a number of anticoagulation treatment have been used, including heparins, fondaparinux, vitamin K antagonists (warfarin, acenocoumarol), and new oral anticoagulants such as apixaban. For years there has been great controversy regarding the use of anticoagulants in planning dental treatments that imply bleeding. The main concerns about using new oral anticoagulants in invasive dental procedures are bleeding due to the lack of an antidote, and the thrombotic risk of the disease for which anticoagulation was indicated in the first place. Material and Methods A literature search was conducted through May 2014 using the keyword “apixaban” for publications in the ISI Web of Knowledge. The search was extended to other databases (PubMed, Scopus and the Cochrane Library). Results Based on the results of the different studies, apixaban seems to be a good alternative to conventional anticoagulation and a reasonable treatment option, though its main and most common adverse effect is bleeding. Dose adjustment is needed in some patients, though regular laboratory monitoring is not required. The use of the drug in different patient populations will define its final indications and doses. Conclusions Regarding the use of apixaban in the dental setting, there is a compelling need for further clinical studies in order to establish more evidence-based guidelines for patients requiring antithrombotic treatment. Key words:Apixaban, dental treatment, dental implications.

Serum levels of RANKL and OPG, and the RANKL/OPG ratio in bisphosphonate-related osteonecrosis of the jaw: are they useful biomarkers for the advanced stages of osteonecrosis?

Background We determined whether serum levels of Receptor Activator for Nuclear Factor κ B Ligand (RANKL), Osteoprotegerin (OPG), and the RANKL/OPG ratio could be useful biomarkers for the severity of oral lesions in bisphosphonate-related osteonecrosis of the jaw (BRONJ). Material and Methods A case-control study in which Group 1 consisted of 41 patients with BRONJ due to intravenous bisphosphonates, and Group 2 consisted of 44 healthy control cases. The plasma levels of RANKL and OPG were analyzed by an ELISA assay. The OPG/RANKL ratio was also calculated. We determined if the mean serum values differed among the different stages of BRONJ. Results Serum levels of RANKL were lower in Group 1 than in Group 2 (p =0.01), and serum levels of OPG were higher in patients with BRONJ than in the controls (p =0.006). The ratio of RANKL/OPG was greater in the controls than in Group 1 (P >0.01). There were no significant differences in the serum levels of RANKL and OPG among the different stages of osteonecrosis (P > 0.05). Conclusions Serum levels of RANKL and OPG, and the RANKL/OPG ratio were not valuable biomarkers for determining the severity of oral lesions in patients with BRONJ. Key words:Bisphosphonates, RANKL, OPG, Osteonecrosis.