Cabbar Fatih, Güler Nurhan, Comunoğlu Nil, Sençift Kemal, Cöloğlu Sedat
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Yeditepe, Istanbul, Turkey.
J Oral Maxillofac Surg. 2008 Oct;66(10):2004-11. doi: 10.1016/j.joms.2008.06.011.
The aim of this study is to determine the proliferative potentials of dental follicles (DF) of radiographically asymptomatic impacted third molar teeth by using Ki-67 and mini-chromosome maintenance protein 2 (MCM-2) proliferation markers, and to discuss whether there is any necessity for the removal of all impacted third molars by detecting the potential of the developing cysts and tumors of its DF.
This study involved 59 DF of 54 patients referred for clinically and radiographically asymptomatic lower impacted third molars. Thirteen healthy gingiva tissues obtained during the impacted third molar operation in 13 patients served as a control group. DF widths on periapical radiographs below 2.5 mm were included in the study. The epithelial and mesenchymal components of DF were examined histologically. All specimens were stained with periodic acid Schiff, Alcian blue, and mucin for the evaluation of mucous cell prosoplasia. Epithelial cell proliferation was determined by using immunohistochemical labeling.
The histologic examinations showed 11.9% mucous cell prosoplasia, 55.9% squamous metaplasia, 15.3% glandular epithelium, and 33.9% inflammation. Ki-67 expression was found to have higher values than MCM-2 expression in controls 6.15 (3.18) and 10.53 (5.77) and in DF 4.46 (1.39) and 5.89 (2.89), respectively. The expression of both proliferation markers in the basal epithelial cells, mucous, and squamous epithelium and inflammatory cells were statistically significant (P < .01).
The results of this study indicate that the odontogenic epithelium in DF of asymptomatic impacted third molars might be actively proliferating and may be an indicator for the differentiation potential of DF. It would also seem that the inflammation observed in the mesenchymal components of DF up-regulate the cell turnover of odontogenic epithelium and lead to proliferation. Based on these observations, we support prophylactic removal of impacted third molars.
本研究旨在通过使用Ki-67和微小染色体维持蛋白2（MCM-2）增殖标志物来确定影像学无症状的阻生第三磨牙牙囊（DF）的增殖潜能，并通过检测其DF发生囊肿和肿瘤的可能性来探讨是否有必要拔除所有阻生第三磨牙。
本研究纳入了54例因临床和影像学检查均无症状的下颌阻生第三磨牙而转诊的患者的59个DF。在13例患者的阻生第三磨牙手术过程中获取的13个健康牙龈组织作为对照组。根尖片上DF宽度小于2.5mm的纳入研究。对DF的上皮和间充质成分进行组织学检查。所有标本用高碘酸希夫染色、阿尔辛蓝染色和黏液染色以评估黏液细胞化生。通过免疫组织化学标记确定上皮细胞增殖。
组织学检查显示黏液细胞化生占11.9%，鳞状化生占55.9%，腺上皮占15.3%，炎症占33.9%。在对照组中，Ki-67表达值高于MCM-2表达值，分别为6.15（3.18）和10.53（5.77）；在DF中分别为4.46（1.39）和5.89（2.89）。两种增殖标志物在基底上皮细胞、黏液和鳞状上皮以及炎症细胞中的表达均具有统计学意义（P <.01）。
本研究结果表明，无症状阻生第三磨牙DF中的牙源性上皮可能在积极增殖，并且可能是DF分化潜能的一个指标。DF间充质成分中观察到的炎症似乎也会上调牙源性上皮的细胞更新并导致增殖。基于这些观察结果，我们支持预防性拔除阻生第三磨牙。
