Javier Silvestre-Rangil

Background: The aim of this study was to analyze the success of dental implants in patients with functional diversity by comparing success rates and marginal bone loss with those observed in patients without functional diversity, with both groups being subjected to a strict implant maintenance and hygiene protocol. Methods: A retrospective observational case–control study was designed. Two main study groups were established: one comprising patients with functional diversity (case group) and another including patients without functional diversity (control group), all of whom had received dental implants. Implant success rates were evaluated 12 months after prosthetic loading. Marginal bone loss was quantified according to the classification proposed by Lagervall and Jansson, later modified and validated by Corcuera-Flores et al. In addition, the Silness and Löe plaque index, presence of bruxism, implant characteristics, and rehabilitation techniques were recorded at each follow-up visit. Results: A total of 63 dental implants were placed in 20 patients included in the present study. The case group consisted of 9 patients who received 31 implants, whereas the control group comprised 11 patients who received 32 implants. No statistically significant differences were observed between groups in terms of implant success and MBL. Oral hygiene was assessed showed a statistically significant difference between groups (p = 0.001). Significant differences were also found regarding bruxism prevalence between groups, which was higher in the case group. Conclusions: The results obtained in the present study indicate that implant therapy in patients with functional diversity can achieve success rates comparable to those observed in patients without disabilities despite the higher prevalence of bruxism and a greater amount of dental plaque. These findings reinforce the importance of individualized treatment planning, adequate oral hygiene control, and periodic clinical follow-up in order to ensure long-term implant stability and peri-implant health.

Gingival inflammation has been increasingly linked to metabolic and endocrine disorders, such as polycystic ovary syndrome (PCOS). This connection may involve immune system activation and cellular stress mechanisms, particularly the unfolded protein response (UPR), which regulates endoplasmic reticulum (ER) stress. The aim of the study was to investigate whether gingivitis modulates UPR activation in peripheral blood mononuclear cells (PBMCs) of women with PCOS. In this case-control study, female subjects were divided into 2 groups: a control group (n = 48); and a PCOS group (n = 68), which included 24 individuals with gingivitis (PCOS+). Anthropometric, biochemical and periodontal parameters were determined, namely probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque index. Markers of oxidative stress, including total superoxide and glutathione peroxidase 1 (GPx1), and UPR mediators, such as glucose-regulated protein 78 (GRP78), activating transcription factor 6 (ATF6), phosphorylated eukaryotic initiation factor 2 alpha subunit (p-eIF2α), and C/EBP homologous protein (CHOP), were evaluated in PBMCs. Polycystic ovary syndrome was associated with an increased plaque index and significantly higher BOP in PCOS+. Increased superoxide and reduced GPx1 levels were observed in women with PCOS, with no significant differences between subgroups. Gingivitis in PCOS was correlated with the activation of specific UPR pathways; higher levels of p-eIF2α and CHOP and lower GRP78 levels were detected in PCOS+, while ATF6 was increased in the overall PCOS group. Moreover, BOP demonstrated a direct correlation with p-eIF2α and the plaque index. The association of leukocyte ER stress responses in PCOS with gingival inflammation underscores the impact of periodontal disease on modulating systemic cellular stress in the context of multifactorial metabolic disorders.

Background: The progressive aging of the population has led to an increased prevalence of chronic diseases and polypharmacy, with arterial hypertension representing one of the most frequent conditions. Consequently, the management of vital signs during dental interventions, such as tooth extractions, has acquired particular clinical relevance. The present study aimed to analyze the hemodynamic impact of vasoconstrictors (VAs) used in local anesthesia (LA) at different procedural stages in patients with pharmacologically controlled hypertension, as well as to compare these effects with those observed in normotensive individuals. Additionally, the study evaluated the influence of antihypertensive medication on hemodynamic responses during dental extraction. Methods: A case–control study was conducted at Dr. Peset University Hospital (Valencia, Spain), including 254 patients—148 hypertensive (controlled with type 1 and 2 antihypertensive therapy) and 106 normotensive controls. Hemodynamic parameters—systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and oxygen saturation (SO₂)—were recorded at four time points: baseline (T1), five minutes post anesthesia with 4% articaine and epinephrine (T2), upon completion of extraction (T3), and one week postoperatively (T4). Results: The SBP remained more stable in normotensive patients, while both groups exhibited a slight DBP decrease at T2, with recovery by T3. In hypertensive patients treated with angiotensin receptor blockers (ARBs), DBP decreased further. Tooth extraction under controlled hypertension conditions caused a mild, clinically insignificant increase in HR. Conclusions: Significant fluctuations in SBP, DBP, and SO₂ occurred during dental extraction, underscoring the necessity for vigilant intraoperative monitoring and individualized management of hypertensive patients.

Asthma is considered to be the most common chronic respiratory disorder in children, and it has been suggested that asthmatic children may be at an increased risk of developing gingival disease. A study was made to evaluate the level of oral hygiene and gingival health in asthmatic children, and to explore their possible relationship with the severity of asthma. A total of 187 children (108 with asthma and 79 healthy controls) between 6-16 years of age were studied. A questionnaire was used to collect information on habits of oral hygiene. The presence of mouth breathing was recorded, and an oral clinical examination was carried out based on the following indices: Silness-Löe plaque index, simplified Greene-Vermillion oral hygiene index, Löe-Silness gingival index, Ainamo and Bay bleeding on probing index, and the community periodontal index (CPI). The severity of asthma was classified following the recommendations of the Spanish Guide on the Management of Asthma (Guía Española para el Manejo del Asma [GEMA]). The level of oral hygiene was similar in both groups. Mouth breathing was more frequent among the asthmatic children (p<0.001), and the gingival index and bleeding on probing scores were higher (p=0.005 and p=0.013, respectively). Mouth breathing was more common in the asthmatic children, and they had higher gingival index and bleeding on probing scores than the healthy controls, despite good habits of oral hygiene.

Polycystic ovary syndrome (PCOS) is a complex condition associated with chronic inflammation and oxidative stress and is often linked to periodontal diseases. This study aimed to determine whether gingivitis modulates the NLRP3 inflammasome in peripheral blood mononuclear cells (PBMCs) from women with PCOS. Following a case-control design, 104 women were divided into three groups: controls (n = 36), PCOS without gingivitis (PCOS, n = 44) and PCOS with gingivitis (PCOS+, n = 24). Periodontal parameters, proinflammatory regulators (NFκB p65, JNK), NLRP3 components (NLRP3, ASC, procaspase-1, caspase-1) and oxidative stress markers (superoxide, NRF2, GCLC and GSR) were determined. The PCOS+ group presented elevated values for bleeding on probing (BOP) and plaque and calculus indices, both of which were associated with increased protein levels of NFκB p65 and JNK, thus indicating NLRP3 inflammasome priming. Higher protein levels of NLRP3, ASC, procaspase-1 and caspase-1 in the PCOS+ group confirmed that priming had occurred, suggesting an engagement in assembly. When potential assembly signals of inflammasome were evaluated, the patients with PCOS generally presented enhanced total superoxide and an impaired antioxidant response (NRF2, GCLC and GSR). Moreover, BOP was independently associated with JNK, ASC and procaspase-1. These findings suggest that gingival inflammation modulates the innate immune response in leukocytes of women with PCOS via the NLRP3 inflammasome pathway, which is regulated by proinflammatory factors and oxidative damage.

(1) Background: The relationship between periodontitis and systemic pathologies continues to grow. Recently, the presence of periodontal pathogens has been linked to an increased risk of pancreatic cancer (PC) and its mortality. Thus, a systematic review is needed to identify whether an association between the two diseases can be established. The objective of this review is to elucidate the mechanisms responsible for this association. (2) Methods: A systematic review was carried out using three databases (PubMed, Embase and Scopus) with the following keywords “Periodontitis AND pancreatic cancer”. A total of 653 articles were retrieved; before selection and screening, the inclusion and exclusion criteria were defined, resulting in a total of 13 articles being included in the review. (3) Results: The increase in low-grade systemic inflammation, pH changes, and the cytotoxicity of certain periodontopathogenic bacteria were found in the scientific literature reviewed as mechanisms linking periodontitis with the risk of PC. (4) Conclusions: Through this systematic review, we have seen how periodontitis can be related to PC and how it worsens its prognosis. Knowing the behavior of periodontopathogenic bacteria and the influence they have on our immune and inflammatory system may help to achieve an interdisciplinary approach to both pathologies.

(1) Background: Psoriasis is a chronic and inflammatory systemic disease that has been associated with periodontal pathologies, specifically periodontitis. The aim of this research is to answer the following question: Could periodontitis aggravate psoriasis? (2) Methods: We carried out a systematic review following the PRISMA guide using PubMed, Embase, Scopus, and WOS; (3) Results: A total of 111 studies were identified in the databases and 11 were obtained after screening. The selection included nine case–control studies, one cross-sectional study, and one cohort study. Most of the publications report an increase in bleeding on probing and the presence of periodontal pockets in patients with psoriasis, confirming that inflammation caused by periodontitis can contribute to systemic inflammation worsening psoriasis. To summarize, the scientific literature indicates that local periodontal inflammation could aggravate psoriasis.

Background: To analyze the prevalence, type and severity of malocclusions in a group of patients with cerebral palsy (CP) using a facial and occlusal analysis and the Dental Aesthetic Index (DAI). Methods: A prospective, case–control study was made of two groups, a cerebral palsy and a control group, with the determination of the facial and occlusion analysis in the three spatial planes. The Dental Aesthetic Index (DAI) was used to assess the severity of malocclusion. Results: The patients with CP presented a higher prevalence of increased facial lower third height and a greater tendency towards right-side canine and molar class II malocclusion, narrower transverse relationship and crossbite. The DAI scores were statistically significantly higher in the CP group. Increased physical impairment in the CP group was associated to greater DAI scores. Conclusions: The prevalence and severity of malocclusion were significantly greater in the CP group. The type of malocclusion predominantly found in these patients was molar class II, with open bite, increased overjet and a narrow arch. The CP group also presented mixed breathing with higher DAI scores and decreased facial lower third height.

To determine the influence of dental anxiety and the vasoconstrictor used in local anesthesia upon different hemodynamic parameters - systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR) and peripheral oxygen saturation (SatO2) - during dental extraction and oral hygiene. The safety of local anesthesia with vasoconstrictor in patients with medically controlled hypertension was also assessed. A total of 159 patients were divided into two groups according to the dental treatment received: tooth extraction (n = 106) and oral hygiene (n = 53). The hemodynamic parameters (SBP, DBP, HR and SatO2) were recorded throughout dental treatment. Patient anxiety was assessed using the Beck Anxiety Inventory (BAI), the Modified Corah’s Dental Anxiety Scale (MDAS) and the Hamilton test. The HR increased after anesthetic infiltration with vasoconstrictor and decreased after the tooth extraction. However, HR remained stable in the oral hygiene group, in both hypertensive and non-hypertensive patients. The SatO2 values decreased after anesthetic infiltration with vasoconstrictor. These slight changes associated with the vasoconstrictor agent were observed in patients without anxiety, but not in patients with mild or moderate anxiety. Both SBP and DBP remained constant after local anesthetic infiltration with vasoconstrictor, regardless of whether the patients presented hypertension or moderate anxiety. The vasoconstrictor used in local anesthesia may induce a very subtle increase in HR, with no significant increase in patients who experience anxiety. Key words:Tooth extraction, dental anesthesia, vasoconstrictor agents, dental anxiety, hypertension.