Ana Rita Castro

Background: Peri-implantitis is an inflammatory condition caused by bacterial plaque and several factors like diabetes, smoking, titanium bio-tribocorrosion, implant–abutment micromovements, occlusal overload, cement remnants, and poor oral hygiene, resulting in bone resorption. The aim of this review was to evaluate the relationship between titanium metal particles and the development of peri-implantitis, specifically the characterisation of the inflammatory response regarding cytokine profile, immune cell infiltration, and transcription factors up-regulated in the peri-implant sites. Methods: A systematic review was conducted following the PRISMA guidelines, from January 2004 to January 2025, in three databases: PubMed, Web of Science, and Wiley Library. The inclusion criteria included in vivo human studies and in vitro studies with a focus on bio-tribocorrosion of titanium particles in peri-implant tissues, and their immunological and cellular implications. Quality assessment of in vivo transversal and case–control studies used Joanna Briggs Institute Critical Appraisal Tools, and, for in vitro studies, the modified CONSORT checklist. Results: A total of 27 studies were included, 20 in vitro and 7 in vivo. Titanium particles induced the secretion of IL-1β, IL-6, and TNF-α by peri-implant cells, activation of the NLRP3 inflammasome, and RANKL/OPG bone resorption, further stimulating an exacerbated inflammatory response, LPS independent. There was a significant increase in IL-33, an alarmin, possibly associated with implant–pillar micromovements. IL-8 production by gingival stromal cells and fibroblasts, and downregulation of CCR7 can explain an altered leukocyte migration and the mixture of M1/M2 macrophage populations in peri-implantitis. Conclusions: Titanium particle bio-tribocorrosion stimulates a chronic inflammatory response impacting immune cell composition and cytokine secretion in peri-implant tissue, leading, ultimately, to osteolysis. Modulation of the immune response may contribute to the development of therapeutic strategies and the prevention of implant failure.

Acute lymphocytic leukemia (ALL) is the most frequent form of all childhood leukemias, mostly affecting children between 2 and 4 years old. Oral symptoms, such as mouth ulcers, mucositis, xerostomia, Herpes or Candidiasis, gingival enlargement and bleeding, petechiae, erythema, mucosal pallor and atrophic glossitis, are very common symptoms of ALL and can be early signs of the disease. Secondary and tertiary complications, a direct effect of chemo and radiotherapy, are associated with more severe bleeding, higher susceptibility to infections, ulcerations, inflammation of the mucous membranes, osteoradionecrosis, xerostomia, taste alterations, trismus, carious lesions and dental abnormalities. Immunotherapy, though less toxic, causes oral dysesthesia and pain. Overall, the effects in the oral cavity are transient but there are long-term consequences like caries, periodontal disease and tooth loss that impair endodontic and orthodontic treatments. Also, dental abnormalities resulting from disturbed odontogenesis are known to affect a child’s quality of life. The medical dentist should identify these complications and perform appropriate oral care in tandem with other health professionals. Thus, poor oral hygiene can lead to systemic ALL complications. The aim of this review is to describe the oral complications in children with ALL who are undergoing chemo, radio or immunotherapy.

Background: Multiple sclerosis is an autoimmune disease of the central nervous system with neurological and motor symptoms that affect the orofacial region. The aim of this work is to present a patient that lacks the three classic orofacial manifestations but has other less common clinical alterations. Case presentation: A 49-year-old female patient diagnosed with long-term relapsing–remitting multiple sclerosis visited the dentist complaining of mild but persistent orofacial pain including the temporomandibular joint and pain not specific to any tooth. She presented mucosal irritation, xerostomia, halitosis, and localized gingivitis. There was excessive wear of the upper and lower incisal edges and the occlusal faces of the upper canines and loss of six teeth due to caries. After a clinical oral examination, the diagnosis was temporomandibular joint disorder, gingivitis, dental hypersensitivity, bruxism, hyposalivation, xerostomia, and halitosis. Conclusions: Patients with multiple sclerosis present classic orofacial manifestations. Although these were not observed in this patient, she had others, such as gingivitis, tooth hypersensitivity, and bruxism. In addition, despite few studies associating a higher prevalence of caries with these patients, the number of carious and missing teeth in this patient highlight the evidence that multiple sclerosis has had a significant impact on the patient’s dental status over the years.

Under the influence of a chronic permanent stress, the adrenal function as well as the entire hypothalamic-pituitary-adrenal axis (HPAA) suffered an adaptation process that resulted in the normalization of the studied stress hormones (ACTH, corticosterone and aldosterone) with the exception of plasma renin activity which first diminished and at the end increased ACTH receptors exhibited a dual response since after 14 days of permanent stress MC2-R showed a slight reduction while MC5-R was still up-regulated.