O objetivo deste trabalho foi de avaliar em Modelo animal, coelhos (raça Nova Zelândia) divididos em três grupos randomizados, (jovem com 60 dias (G1), um idoso com aterosclerose e ingestão de colesterol (G2) e um idoso com aterosclerose e sem ingestão do colesterol (G3)) se, a dieta rica em colesterol e a idade, causam lesões de aterosclerose e placas ateroscleróticas nos animais, alterações nos comprimentos dos dentes, aumento ou diminuição dos espaços periapicais dos dentes, perda óssea alveolar na maxila e mandíbula. Através da metodologia descrita e após as análises histológicas e morfológicas, verificou-se diferença estatisticamente significante, nas variáveis dos comprimentos dos dentes 1º prémolares superiores entre os grupos G3 versus G1 p<5%. médias de 1247,88 (p=0,017) e G3 versus G2, com diferença das médias de 1190,85 (p=0,025) ou seja o comprimento dos dentes fora diferente no grupo G2. Com relação à variável, espessura do osso alveolar, não ocorreu significância estatística, porém tendências de que este esteja sendo alterado. Com relação a variável espessura do espaço periapical fora verificado significância estatística com p=0,017 em relação ao G1, na região dos 1º Pré-molares, apresentando a diferença das médias (403,42) a favor do G2, ou seja aumento do espaço periapical. A variável da área de placa de aterosclerose, correlacionada, com os comprimentos dos dentes e espessura do osso alveolar, também teve resultado significante na região 1º e 2º pré-molares entre G2 e G3. com p=0,025 e r=0,476. Confirmando assim a correlação da aterosclerose, dietas hiperclesterolêmicas e as alterações da cavidade bucal e estrutura de sustentação dos dentes. / The aim of this study is, to evaluate on animal model (New Zealand rabbits), on different and randomized groups (G1 a young group, G2 an older rabbit, with atherosclerosis and ingesting hipercholesterolemic fat diet and another group G3, just an older group) investigated than the hipercholesterolemic fat diet induced atherosclerotic lesions and plaques in ascendant aorta, bone loss in maxillary and jaw, alterations on length of the tooth, alterations on tooth periapical spaces. By the methodology described and aplicated, before the histological and morphological analysis, was verified significant statistical variance in the length of the first premolar tooth and second premolar on maxillary region, the length of this tooth is reduced in G2 (p<5%). The medias are 1247,88 (p=0,017) and 1190,85 (p=0,025). Analyzing another variable on the alveolar bone thickness, was not found any statistical significance, but tendencies that this event may occur. According to another variable of the thickness found on the periapical space, it was verified a significant variable statistic such as p=0,017 related on G1, on first premolar region, suggesting a different statistic, between medias, favoring G2 meaning the increase of periapical space. The variable on the atherosclerosis plaque area, related to the teeth length and alveolar bone thickness, also showed significant results on first and second premolars regions between G2 and G3, with p=0,025 and r=0,476. That confirms the atherosclerosis correlations and hipercholestrolemic fat diet, also alterations in oral cavity and teeth implantation structure.

Orientador: Paulo Sérgio Flores Campos / Texto do capítulo 1 em inglês / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-20T12:07:20Z (GMT). No. of bitstreams: 1 Vaz_SergioLinsdeAzevedo_M.pdf: 1201820 bytes, checksum: c01a9a7bcc2ca60b934986c91f46e192 (MD5) Previous issue date: 2012 / Resumo: O objetivo neste trabalho foi identificar a exatidão de alguns filtros de imagem na mensuração do nível ósseo peri-implantar, por meio da radiografia digital. Para isso, vinte implantes de titânio (Titamax, Neodent, Curitiba, PR, Brasil) foram instalados em seis fragmentos de costelas bovinas, nas quais foram criados defeitos do tipo perda óssea. Utilizando um sistema intra-bucal de placas de fósforo (Vista Scan, Dürr Dental, Beitigheim-Bissingen, Alemanha), radiografias periapicais foram realizadas posicionando os implantes segundo a técnica do paralelismo. Após a obtenção das imagens, nove filtros do software DBSWIN foram aplicados: fine, caries 1, caries 2, perio, endo, noise reduction, invert, emboss e sculpture. Um avaliador mensurou as distâncias entre o ombro do implante à porção mais apical do defeito no software Image J. Os defeitos também foram mensurados nas costelas bovinas utilizando um paquímetro digital. O teste não-paramétrico de Friedman comparou os valores obtidos nas imagens com aplicação dos filtros aos encontrados nas imagens originais e nas costelas bovinas, adotando nível de significância de 5%. Os resultados mostraram diferenças estatisticamente significantes para os filtros caries1, caries2, endo e perio (P < 0.05) tanto em relação às imagens originais, quanto em relação às mensurações obtidas com o paquímetro. As mensurações obtidas com as imagens originais, filtros fine e emboss foram mais próximas às obtidas com o paquímetro. Concluiu-se que os filtros fine e emboss foram os mais exatos na mensuração do nível ósseo peri-implantar, sendo equiparáveis às imagens originais. Os filtros caries1, caries2, endo e perio foram os menos exatos, não sendo indicados para este fim / Abstract: This study aimed to identify the accuracy of some enhancement filters of an intraoral phosphor-plate system for measuring the simulated periimplant bone level. Twenty titanium implants (Titamax, Neodent, Curitiba, PR, Brazil) were placed into six fragments of bovine ribs and defects simulating bone loss were created. Periapical radiographs were taken with a phosphor-plate system (Vista Scan, Dürr Dental, Beitigheim-Bissingen, Germany) according to the paralleling standard technique, and nine enhancement filters were applied: fine, caries 1, caries 2, perio, endo, noise reduction, invert, emboss and sculpture. An oral radiologist measured on the Image J software the distance from the neck of the implant to the most apical contact of the bone with the implant. The Friedman non-parametric test compared the radiographic measurements to those obtained on the bovine ribs with a digital caliper. The significance level adopted was 5%. The caries1, caries2, endo, and perio filters resulted on measurements statistically different from both the original images and the measures of the digital caliper (P < 0.05). In conclusion, the fine and emboss filters resulted on the most precise filters, with similar measures to the original images. The caries1, caries2, endo, and perio filters were the less accurate for measuring the periimplant bone level / Mestrado / Radiologia Odontologica / Mestre em Radiologia Odontológica

Apesar do caráter cada vez mais preventivo, a Odontologia ainda lida com a realidade terapêutica de reabilitação de uma população cujo mais grave problema de saúde bucal é a ausência dental. A implantodontia apareceu como uma opção para essas reabilitações, porém, não raro, se vê diante de reabsorções ósseas que inviabilizam a instalação direta de implantes. A utilização de enxertos ósseos é o grande recurso para essas áreas. Os enxertos autógenos são uma excelente opção, mas vêm acompanhados de alguns inconvenientes como maior morbidade e risco de infecção, maior tempo de recuperação e maior custo. Esses dificultadores têm contribuído para o desenvolvimento de materiais alternativos. Um desses materiais é o fosfato de cálcio amorfo (FCA), cuja forma cristalina é a hidroxiapatita (HA). Nesse estudo utilizou-se de uma inédita apresentação do mesmo, em forma filamentosa, para avaliar a neoformação óssea na reparação alveolar. A hidroxiapatita em grânulos foi utilizada como referência comparativa. Foram utilizados 44 animais da espécie Rattus Novergicus albinus, linhagem Wistar, machos e adultos. Estes foram submetidos à exodontia do incisivo superior cuja loja alveolar foi imediatamente preenchida com um biomaterial, a saber: FCA, HA e FCAHA (mistura de 50%&#x2d;50% de cada um deles). Ao término de 28 dias foram sacrificados e seus alvéolos analisados em microscopia de luz convencional quantificando a formação de coágulo, a neoformação óssea, a deposição de tecido osteóide e a presença de vasos no tecido de reparação. As células típicas do tecido ósseo se mostraram presentes. Osteoblastos e osteoclastos na superfície das trabéculas e profusão de fibroblastos no tecido ósseo imaturo, ocupando os espaços intertrabeculares. A deposição de tecido osteóide e de tecido ósseo neoformado apresentou-se em todos os grupos, porém com diferenças em relação à sua distribuição. O grupo controle apresentou reparação óssea compatível com o clássico descrito em literatura, ou seja, de maneira centrípeta. Também foi evidenciada a presença de um coágulo central ou paracentral em relação ao alvéolo. No grupo FCA a quantidade de tecido ósseo neoformado era mais evidente do que nos demais. Já no grupo HA a presença dos cristais sugeriu uma concorrência espacial com a formação tecidual. No grupo FCAHA a deposição tecidual mostrou-se nitidamente irregular. Nos grupos onde foi utilizado o FCA a deposição de tecido ósseo neoformado foi superior àqueles onde esse biomaterial não estava presente. Nosso estudo sugere que o FCA tem uma característica osteoindutora mais evidente do que a HA. Justifica-se por, dentro do período estudado, verificar-se o maior depósito de tecido neoformado e a menor quantidade de tecido osteóide quando os comparamos com os outros grupos. Concluímos que o FCA apresentado na forma de filamentos comportou-se in vivo com características comparáveis a de outros materiais biocompatíveis, mostrando boa resposta osteoindutora, e uma reparação e neoformação mais rápida que a da HA / Despite it increasingly preventive character, dentistry also deals with the reality of therapeutic rehabilitation of a population whose most serious oral health problem is dental absence. Dental implant appeared as an option for these rehabilitations, however, often, is faced with bone resorption that prevent direct implant placement. The use of bone grafts is a great resource for those areas. Autogenous grafts are an excellent option, but comes accompanied by some drawbacks as higher morbidity and risk of infection, longer recovery time and higher cost. These have contributed to hindering the development of alternative materials. One such material is amorphous calcium phosphate (ACP), which is the crystalline form hydroxyapatite (HA). In this study, we used an unprecedented presentation of the same in filamentous form, to evaluate new bone formation in the alveolar repair. The hydroxyapatite granules was used as a comparative reference. 44 animals were used species Rattus Novergicus Albinus, Wistar, adult males. These were subjected to extraction of the upper incisor whose cellular store was immediately filled with a biomaterial, namely: ACP, and ACPHA (mixture of 50% &#x2d;50% of each). At the end of 28 days they were sacrificed and their alveoli analyzed by conventional light microscopy quantifying clot formation, bone formation, deposition of osteoid tissue and the presence of vessels in tissue repair. The cells typical of bone tissue showed present. Osteoblasts and osteoclasts on the surface of trabecular and profusion of fibroblasts in the immature bone tissue, occupying the intertrabecular spaces. The deposition of osteoid tissue and newly formed bone appeared in all groups, but with differences regarding their distribution. The control group exhibited bone repair compatible with the classic described in the literature, centripetal manner. In addition, it revealed the presence of a central clot or para in relation to the alveolus. ACP group in the amount of newly formed bone was more evident than in others. Already in the HA group the presence of crystals suggested a space competition with tissue formation. The group ACPHA tissue deposition was shown to be clearly irregular. In groups which was used ACP deposition of newly formed bone was higher than those where this biomaterial were not present. Our study suggests that the ACP has clearer osteoinductive characteristic of the HA. Justified by, within the study period, check it the largest deposit of newly formed tissue and the least amount of osteoid tissue when compared with the other groups. We conclude that the ACP presented in the form of filaments behaved in vivo comparable characteristics of other biocompatible materials, showing good osteoinductive response, a faster repair and neogenesis the HA

This work aims to investigate, from the perspective of the Acoustic Theory of Speech Production, the occurrence of palatalization of alveolar nasal from the analysis of speech data of three women born in União dos Palmares. Considering that most of the studies on palatalization in Brazil are devoted to analyzing the stops / t, d /, this study has its relevance, since it is dedicated to another segment susceptible to this process. The data was analyzed using the PRAAT computational application to describe the visual parameters in order to describe the visual parameters from the observation of the trajectory of the formants in the spectrum that can be interpreted as a lane for the point of articulation. In addition, using the R program package, we analyzed if are difference in distribution of values of frequencies of F1, F2 e F3 and we observe the interference of adjacent contexts to the alveolar nasal in the palatalization process. The results indicated the occurrence of three variants, namely: [n], [nʲ] and [ɲ]. The distinction of the variants was obtained from the observation of the frequency relation of F2 and the other frequencies, as the more the tongue approaches the palatal region, the more F2 increases. As for the influence of the phonetic environment, the upper segments seem to favor the process. / FAPEAL - Fundação de Amparo à Pesquisa do Estado de Alagoas / Este estudo tem por objetivo investigar, sob a perspectiva da Teoria Acústica da Produção da Fala, a ocorrência de palatalização da nasal alveolar a partir da análise de dados de fala de três mulheres nascidas em União dos Palmares. Considerando que grande parte dos estudos sobre palatalização no Brasil se dedica a analisar as oclusivas /t, d/, este estudo tem sua relevância, pois se dedica a outro segmento suscetível a esse processo. Os dados são analisados utilizando o aplicativo computacional PRAAT de modo a descrever os parâmetros visuais a partir da observação da trajetória dos formantes no espectro que são interpretados como pista para o ponto de articulação. Além disso, utilizando o pacote de programas R, analisamos se há diferença na distribuição dos valores das frequências de F1, F2 e F3 e observamos a interferência dos contextos adjacentes à nasal alveolar no processo de palatalização. Os resultados apontam a ocorrência de três variantes, a saber: [n], [nʲ] e [ɲ]. A distinção das variantes se deu a partir da observação da relação da frequência de F2 e as demais frequências de modo que quanto mais a língua se aproxima da região palatal, mais F2 aumenta. Quanto à influência do ambiente fonético, os segmentos altos parecem favorecer o processo.

Indiana University-Purdue University Indianapolis (IUPUI) / Exodontia, or extraction of teeth, has been a well-documented dental treatment that forms one of the foundations of dentistry. The steps associated with extracting teeth have changed little in the last century and these steps are largely part of the dogma of dentistry. One such step is that of socket compression post-extraction. Rationale for socket compression after extraction is manifold. They include: shorter healing times, fewer dry sockets and re-approximating walls that were stretched in the elevation and delivery stages of extractions. The purpose of this study was to determine if post-extraction ridge compression negatively affected alveolar ridge dimensions when compared to sites that are not compressed post-extraction. Secondary outcome measures will identify if socket compression/re-approximation affects the rate of soft tissue closure or occurrence of alveolar osteitis. In this study, 14 subjects were recruited. Eight subjects formed the compression group, while six formed the non-compression group. The subjects in the compression group received compression of their alveolar ridges after extraction to approximate their original pre-extraction width. The subjects in the non-compression group did not receive ridge compression. Each subject had pre-extraction and post-extraction CBCT scans along with post-operative follow up visits at 1, 2, and 4 weeks post-extraction. The present investigation found that with respect to changes in ridge width, sites that were compressed did not lose significantly more dimension than those that were not. With respect to ridge height, sites that were compressed did not lose significantly more dimension than those that were not. Sites that were compressed and sites that were not, healed at approximately the same rate, with respect to soft tissue closure. While the results showed a lack of statistical significance between both groups, there appears to be a trend towards the ridge compression group having a smaller ridge width. Such a trend was not noted with soft tissue closure, thereby invalidating the rationale for socket compression after extraction. One of the limitations of this pilot study is the small sample size. Further validation of these results must be done with a larger sample size in order to provide clinical guidance to dental practitioners.

Pneumonia is considered to be one of the leading causes of death worldwide. The outcome depends on both, proper antibiotic treatment and the effectivity of the immune response of the host. However, due to the complexity of the immunologic cascade initiated during infection, the latter cannot be predicted easily. We construct a biomathematical model of the murine immune response during infection with pneumococcus aiming at predicting the outcome of antibiotic treatment. The model consists of a number of non-linear ordinary differential equations describing dynamics of pneumococcal population, the inflammatory cytokine IL-6, neutrophils and macrophages fighting the infection and destruction of alveolar tissue due to pneumococcus. Equations were derived by translating known biological mechanisms and assuming certain response kinetics. Antibiotic therapy is modelled by a transient depletion of bacteria. Unknown model parameters were determined by fitting the predictions of the model to data sets derived from mice experiments of pneumococcal lung infection with and without antibiotic treatment. Time series of pneumococcal population, debris, neutrophils, activated epithelial cells, macrophages, monocytes and IL-6 serum concentrations were available for this purpose. The antibiotics Ampicillin and Moxifloxacin were considered. Parameter fittings resulted in a good agreement of model and data for all experimental scenarios. Identifiability of parameters is also estimated. The model can be used to predict the performance of alternative schedules of antibiotic treatment. We conclude that we established a biomathematical model of pneumococcal lung infection in mice allowing predictions regarding the outcome of different schedules of antibiotic treatment. We aim at translating the model to the human situation in the near future.

Cigarette smoke contributes to many diseases. The actions of second and third hand smoke, which have implications for non-smokers and the very young, are just beginning to be appreciated. The overarching hypothesis of this project is that cigarette smoke has different injurious actions on alveolar cells based on chronological age. The purpose here was to learn more about the susceptibility of alveolar cells to cigarette smoke extract (CSE)- induced injury by performing studies on pulmonary alveolar and endothelial cells derived from neonatal, young, and old rats. The aims involved: 1. Developing cell culture models to study age-related effects of cigarette smoke on alveolar type I cells and microvascular endothelial cells from the lung, and 2. Using these models to examine the effects of CSE on markers of oxidative stress, inflammation and aging in alveolar cells harvested from neonatal, young and old rats. Descriptive and experimental studies involved using a variety of cell culture, biochemical and molecular techniques, including gene expression arrays. The most significant findings were that: 1. primary proliferating alveolar type I cells were used to develop novel cell culture model systems, including single culture, co-culture and three-dimensional cultures that were used to study the effects of CSE; 2. Hydrogen peroxide production by endothelial cells was markedly reduced by co-culturing with AT I cells; 3. Gene expression profiling of oxidative stress-specific pathways suggest that genes responsible for both stopping production of H2O2 or mopping-up H2O2 are involved; and 4. Cigarette smoke shortens telomeres of cells from neonates, but unexpectedly preserves telomere length of cells from young and old rats. Data from telomeric pathway-specific gene expression arrays suggest that there are age-related differences in response to gene expression to CSE. The significant conclusions are: 1. Contrary to prior observations, alveolar type I cells demonstrate prolonged proliferative capacity; 2. Alveolar type I cells likely play an important role in ameliorating CSE-induced oxidative stress; and 3. Neonatal alveolar cells may be more susceptible to the deleterious effects of CSE including telomere shortening. These novel model systems and observations provide new ways to study cigarette smoke-associated lung dysfunction.

Orientador: Maria José Hitomi Nagata / Coorientador: Valdir Gouveia Garcia / Coorientador: Letícia Helena Teodoro / Banca: Valdir Gouveia Garcia / Banca: Alvaro Francisco Bosco / Banca: Cláudio Aparecido Casatti / Banca: João Batista César Neto / Banca: Márcio Zaffalon Casati / Resumo: Este estudo avaliou histomorfometricamente, imunoistoquimicamente e pela reação em cadeia da polimerase via transcriptase reversa em tempo real (qRT-PCR) os efeitos da Terapia com Laser em Baixa Intensidade (LLLT) e da Terapia Fotodinâmica antimicrobiana (aPDT) adjuvantes ao tratamento mecânico da periodontite experimental (PE) em ratas com deficiência de estrógeno e sob influência sistêmica da nicotina. Foram utilizadas 360 ratas, divididas em 4 grupos: Grupo A (SH-vei) normais, Grupo B (SH-nic) - normais tratadas com nicotina, Grupo C (OVX-vei) - ovariectomizadas e Grupo D (OVX-nic) - ovariectomizadas tratadas com nicotina. A administração de nicotina foi iniciada nos animais do Grupo B (SH-nic) e Grupo D (OVX-nic) 30 dias antes da indução da PE. Os animais dos Grupos OVX-vei e OVX-nic foram submetidos à ovariectomia (OVX) bilateral 21 dias antes da PE realizada por adaptação de fio de algodão ao redor dos primeiros molares inferiores direitos e esquerdos. Após 7 dias, a ligadura foi removida e os animais subdivididos de acordo com os seguintes tratamentos locais realizados nos molares inferiores direitos e esquerdos: RAR - Raspagem e alisamento radicular e irrigação com soro fisiológico; LLLT - RAR e irrigação com soro fisiológico associada à LLLT; aPDT- irrigação com azul de toluidina-O (TBO) e após 1 minuto, irradiação com laser em baixa intensidade. Foram eutanasiados 10 animais de cada subgrupo, aos 7, 15 e 30 dias após o tratamento local. A perda óssea (PO) na furca foi avaliada por meio de análises histomorfométrica e imunoistoquímica. A expressão gênica das citocinas TNF-α, IL-1β e IL-6 foram avaliadas pela qRT-PCR. Os dados foram submetidos à análise estatística (α = 5%). Os animais do Grupo OVX-nic apresentaram maior PO comparativamente ao grupo SH-vei (p<0,05). O tratamento... / Abstract: This study evaluated histomorphometrically, immunohistochemically and by polymerase chain reaction via real-time reverse transcriptase (qRT-PCR) the effects of Laser Therapy in Low Intensity (LLLT) and antimicrobial Photodynamic Therapy (aPDT) adjuncts to mechanical treatment of periodontitis experimental (PE) in rats with estrogen deficiency and under the influence of systemic nicotine. It was used 360 rats divided into 4 groups: Group SH-veh: sham treated with saline (vehicle); Group SH-nic: sham treated with nicotine; Group OVX-veh: ovariectomized treated with saline (vehicle) and Group OVX-nic: ovariectomized treated with nicotine. Nicotine was administered to groups SH-nic and OVX-nic 30 days before the induction of PE. The animals in Groups OVX-veh and OVX-nic underwent ovariectomy (OVX) bilaterally 21 days before PE performed by adaptation of cotton thread around the first molars right and left. After 7 days, the ligature was removed and the animals divided according to the following local treatments performed in the right and left molars: RAR - Scaling and root planing and irrigation with saline; LLLT - RAR and irrigation with saline associated with LLLT; aPDT - irrigation with toluidine blue O (TBO) and after 1 minute irradiation with LLLT. Ten animals were euthanized of each group at 7, 15 and 30 days after treatment site. Bone loss (BL) in the furcation was evaluated by histomorphometric and immunohistochemical analyzes. The gene expression of TNF-α, IL-1β and IL-6 were measured by qRT-PCR. Data were subjected to statistical analysis (α = 5%). The animals of the OVX-nic group showed higher BL group compared with SH-vei (p <0,05). Local treatment with aPDT showed BL reduced, decreased expression of RANKL and the number of TRAP-positive cells and increased the expression of OPG and the number... / Doutor

Com o crescente interesse pela obtenção de estética em reabilitações implanto-suportadas, os tecidos moles peri-implantares vêm sendo alvo de atenção das pesquisas em Implantodontia. A fissura alveolar congênita distingue-se neste contexto por apresentar dificuldades estéticas peculiares. Este estudo retrospectivo qualificou como satisfatória ou deficiente, a estética gengival de 65 próteses unitárias implanto-suportadas em área de fissura enxertada por meio de um novo índice que se baseou nos parâmetros: posição da margem gengival, papilas interproximais e coloração gengival. Procurou-se associar os escores obtidos com este índice, a situações presentes antes da instalação dos implantes (recessão gengival nos dentes vizinhos, bridas musculares, faixa de mucosa ceratinizada), a procedimentos cirúrgicos reconstrutivos (re-enxertos ósseos, enxertos gengivais, técnicas de reabertura a retalho) e ao número de cirurgias e de sessões de condicionamento gengival realizados com o objetivo de obter estética. Foi considerada satisfatória a gengiva peri-implantar de 42 (64,62%) das próteses. A recessão gengival nos dentes vizinhos, presença de bridas musculares e falta de mucosa ceratinizada foram os principais responsáveis pela falta de estética dos demais trabalhos. O único tipo de cirurgia que interferiu no resultado estético foi o enxerto gengival livre epitelizado. O número de sessões de condicionamento gengival não interferiu nos resultados. Concluiu-se que as condições anteriores à instalação dos implantes são mais importantes na obtenção da estética do que os procedimentos posteriores cirúrgicos reconstrutivos ou de condicionamento gengival. Além disto, o índice proposto mostrou-se adequado para o tipo de avaliação executada. / With the increasing interest on the achievement of esthetics in implant-supported rehabilitations, the peri-implant soft tissues have been addressed in several investigations in Implantology. The congenital alveolar cleft is distinguished within this context because of the inherent esthetic impairment. This retrospective study assessed the gingival esthetics of 65 single implant-supported prostheses at grafted cleft areas by a new index based on the following parameters: position of the gingival margin, interproximal papillae and gingival color. Esthetics was scored as satisfactory or poor. The scores achieved by this index were associated to the status before and after placement of the implants (gingival recession of the adjacent teeth, buccal frenula, width of keratinized mucosa), to the reconstructive surgical procedures (bone grafts, gingival grafts, reopening and flap techniques), and to the number of surgeries and gingival conditioning sessions performed to achieve esthetics. The peri-implant gingiva of 42 prostheses (64.62%) was considered satisfactory. Gingival recession on the adjacent teeth, presence of buccal frenula and lack of keratinized mucosa were the main factors influencing the poor esthetics of the other prostheses. The only type of surgery that interfered with the esthetic outcome was the epithelialized free gingival graft. The number of gingival conditioning sessions did not interfere with the outcomes. It was concluded that the status before placement of the implants are more important for achievement of esthetics than the reconstructive surgical posterior procedures or gingival conditioning. Moreover, the index proposed was adequate for this type of evaluation.

Le parasite Echinococcus multilocularis cause l’échinococcose alvéolaire (EA), infection fatale si non prise en charge. Le traitement médical, pour les patients inopérables, est uniquement parasitostatique, et présente des effets secondaires. Néanmoins, chez certains patients, la viabilité du parasite régresserait suffisamment pour envisager un arrêt de ce traitement. Actuellement, les biomarqueurs pour estimer la viabilité parasitaire ne sont qu’indirects, évaluant la réponse immunitaire du patient. Trois études ont été menées, visant à évaluer des biomarqueurs, innovants ou déjà disponibles sur le marché.Nous avons étudié la présence d’ADN libre circulant (ADNlc), au moment du diagnostic, mais aussi quelques mois après la mise en place du traitement. Notre étude valide pour la première fois la présence d’ADNlc dans les cas d’EA, sur modèle animal puis sur des échantillons de patients. Même si la méthode n’est pas encore utilisable en diagnostic ou en suivi, c’est un point de départ vers l’utilisation de l’ADNlc pour la prise en charge de l’EA.De plus, nous avons mené une étude exploratoire sur des lésions parasitaires chez la souris et chez un patient ayant reçu un traitement médicamenteux très court. A partir d’un même échantillon, nous avons analysé l’ADN, afin d’estimer la proportion de cellules parasitaires, et nous avons quantifié différents transcrits parasitaires, afin d’estimer la viabilité du parasite de manière directe. Cet axe a permis de choisir la cible la plus transcrite : elle pourrait être utilisée sur une cohorte plus large, puis corrélée avec les biomarqueurs indirects utilisés aujourd’hui.Enfin, nous avons évalué un test de diagnostic rapide de l’échinococcose kystique, présentant de fortes réactions croisées en cas d’EA.Ces travaux ouvrent de nouvelles perspectives, principalement pour améliorer le suivi des patients atteints d’EA. / The parasite Echinococcus multilocularis is the causative agent of alveolar echinococcosis (AE), a fatal infection if not adequately managed. Medical treatment, for inoperable patients, is only parasitostatic, with many side effects. Nevertheless, in some patients, the viability of the parasite could regress sufficiently for treatment to be stopped. Currently, biomarkers for estimating parasite viability are only indirect, evaluating the immune response of the patient. Three studies were conducted to evaluate biomarkers that are innovative or already available on the market.We investigated the presence of circulating cell-free DNA (ccfDNA) at diagnosis, and after a few months of treatment. For the first time, our study identified the presence of ccfDNA in cases of AE, in an animal model and in human samples. Although the method cannot yet be used for diagnosis or follow-up, it is a starting-point for the use of ccfDNA in the management of AE.In addition, we conducted an exploratory study of parasitic lesions in mice, and in a patient who had only received medical treatment for a very short time. We analyzed DNA to estimate the proportion of parasite cells present in each sample. We then quantified different parasite transcripts from each sample, in order to directly estimate parasite viability. This approach allowed us to identify the most abundantly transcribed gene, which could potentially be used to study a larger cohort, in order to correlate results with the indirect biomarkers used today.Finally, we evaluated a rapid diagnostic test for cystic echinococcosis, which produces strong cross-reactions in the case of AE infection.This work opens new perspectives, mainly to improve the follow-up of patients with AE.