Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2015-10-22T17:34:42Z No. of bitstreams: 1 MaiaraDeMoraes_TESE.pdf: 4430780 bytes, checksum: 1f816fb63ca894e21d7bb94602ef5210 (MD5) / Approved for entry into archive by Elisangela Moura (lilaalves@gmail.com) on 2015-10-22T21:22:44Z (GMT) No. of bitstreams: 1 MaiaraDeMoraes_TESE.pdf: 4430780 bytes, checksum: 1f816fb63ca894e21d7bb94602ef5210 (MD5) / Made available in DSpace on 2015-10-22T21:22:44Z (GMT). No. of bitstreams: 1 MaiaraDeMoraes_TESE.pdf: 4430780 bytes, checksum: 1f816fb63ca894e21d7bb94602ef5210 (MD5) Previous issue date: 2014-06-05 / Embora a terapia fotodin?mica venha sendo utilizada como uma ferramenta ?til nos ?ltimos 30 anos em oncologia, poucos estudos cl?nicos em odontologia t?m sido conduzidos. A terapia fotodin?mica (TFD) utiliza fotossensibilizantes at?xicos e seletivos que s?o administrados nas c?lulas alvo seguida de aplica??o local de luz vis?vel, produzindo esp?cies reativas de oxig?nio capazes de ocasionar morte celular por apoptose ou necrose, de afetar a vascularidade local, al?m de exercer importantes efeitos no sistema imune. Novas gera??es de f?rmacos fotossensibilizantes, como as ftalocianinas nanoparticuladas tem apresentado excelentes resultados na atividade antitumoral e antibacteriana. Neste contexto, o presente trabalho realizou o primeiro protocolo cl?nico de aplica??o local da nanoemuls?o de cloro-alum?nio ftalocianina (AlClFc) seguida de irradia??o em gengiva de humanos, e analisou descritiva e comparativamente, por meio de imunoistoqu?mica, a express?o de RANK, RANKL, OPG e VEGF em um modelo split-mouth. Oito volunt?rios saud?veis com indica??o cl?nica de exodontia foram inclu?dos no estudo. Sete dias antes da exodontia, foi aplicado na gengiva dos participantes, 5?M de nanoemuls?o de AlClFc seguida de irradia??o com laser diodo (660nm, 100J/cm2), o lado contralateral foi utilizado como controle. Os esp?cimes teciduais foram removidos sete dias ap?s a TFD e subdivididos em dois grupos (grupo teste e grupo controle) para an?lise histol?gica e imunoistoqu?mica. Os pacientes foram monitorados no dia aplica??o, 7, 14 e 30 dias ap?s a terapia para avalia??o de efeitos adversos da terapia. Altera??es vasculares foram observadas nas amostras gengivais que receberam a TFD. ?reas de edema e congest?o vascular, al?m de intensa vasculariza??o foram visualizadas. Adicionalmente, focos de calcifica??o distr?fica em regi?o subepitelial foram visualizados nos esp?cimes do grupo teste. Os resultados demonstraram um padr?o similar dos escores de imunomarca??o de RANK, RANKL e VEGF entre os grupos teste e controle, n?o havendo diferen?a estat?stica significante (p=0.317, p=0.777, p=.814, respectivamente). RANK e RANKL exibiram imunomarca??o fraca ou ausente em todos os esp?cimes analisados. N?o houve imunomarca??o para a OPG. O VEGF mostrou imunomarca??o moderada a forte nos esp?cimes do grupo teste. Adicionalmente, o estudo cl?nico mostrou que a terapia foi bem tolerada por todos os pacientes. Os efeitos adversos foram de curta dura??o e totalmente revers?veis. Tomados em conjunto, os resultados apresentados neste estudo mostraram que o protocolo da TFD mediada por nanoemuls?o contendo AlClFc ? segura para aplica??o cl?nica em tecido gengival e, sugerem uma forte imunomarca??o para o VEGF ap?s a terapia. / Although photodynamic therapy have been used as a useful tool over the past 30 years in oncology, few clinical trials have been conducted in dentistry. Photodynamic therapy (PDT) uses non - toxic photosensitizers and selective which are administered in target cells followed by local application of visible light, producing reactive oxygen species capable of causing cell death by apoptosis or necrosis, injured the local vasculature, and exert important effects on the im mune system. New generations of photosensitizing agents, such as nanoparticulate phthalocyanines, has shown excellent results in antitumor and antibacterial activity . In this context, the present work constitutes the first clinical protocol of local appli cation of nanoemulsion chloro - aluminum phthalocyanine (AlClFc) followed by irradiation in human gingiva, and analyzed descriptively and comparatively , by means of immunohistochemistry , the expression of RANK , RANKL , OPG and VEGF in a split - mouth model . Eight healthy volunteers with clinical indication for extraction were included in the study . Seven days before the extraction, was injected in the gingiva of participants, 5 ? M of nanoemulsion AlClFc followed by irra diation with diode laser (660nm , 7 J/cm2 ), the contralateral side was used as control. Tissue specimens were removed seven days after the TFD is performed. Tissues sample were divided into two groups (test and con trol groups) for histological and immunohistochemical analysis. Patients were monitored at days, 0, 7, 14 and 30 to assess adverse effects of the therapy. Vascular alterations were seen in gingival samples that received PDT. Areas of edema and vascular con gestion, and intense vascularization were viewed . Additionally, dystrophic calcification in subepithelial region were observed in the test group. The results showed a similar pattern of immunostaining scores of RANK, RANKL and VEGF between the test and co ntrol groups, with no statistically significant difference (p = 0.317, p = 0.777, p = 0 .814, respectively). RANK and RANKL exhibited weak or absent immunostaining in most specimens analyzed. There was n o immunostaining for OPG. VEGF showed moderate to stro ng immunostaining in specimens from the test group. In addition, the clinical study showed that therapy was well tolerated by all patients. Adverse effects were short - time and completely reversible. Taken together, the results presented in this study showe d that PDT mediated by nanoemulsion containing AlClPc is safe for clinical application in gingival tissue and suggests that a strong immunostaining for VEGF after therapy .