Abstract Inducible nitric oxide synthase (iNOS) is one of the enzymes responsible for the synthesis of nitric oxide (NO), which is an important signaling molecule with effects on blood vessels, leukocytes, and bone cells. However, the role of iNOS in alveolar bone healing remains unclear. This study investigated the role of iNOS in alveolar bone healing after tooth extraction in mice. Methodology C57Bl/6 wild type (WT) and iNOS genetically deficient (iNOS-KO) mice were subjected to upper incision tooth extraction, and alveolar bone healing was evaluated by micro-computed tomography (μCT) and histological/histomorphometric, birefringence, and molecular methods. Results The expression of iNOS had very low control conditions, whereas a significant increase is observed in healing sites of WT mice, where iNOS mRNA levels peak at 7d time point, followed by a relative decrease at 14d and 21d. Regarding bone healing, both WT and iNOS-KO groups showed the usual phases characterized by the presence of clots, granulation tissue development along the inflammatory cell infiltration, angiogenesis, proliferation of fibroblasts and extracellular matrix synthesis, bone neoformation, and remodeling. The overall micro-computed tomography and histomorphometric and birefringence analyses showed similar bone healing readouts when WT and iNOS-KO strains are compared. Likewise, Real-Time PCR array analysis shows an overall similar gene expression pattern (including bone formation, bone resorption, and inflammatory and immunological markers) in healing sites of WT and iNOS-KO mice. Moreover, molecular analysis shows that nNOS and eNOS were significantly upregulated in the iNOS-KO group, suggesting that other NOS isoforms could compensate the absence of iNOS. Conclusion The absence of iNOS does not result in a significant modulation of bone healing readouts in iNOS-KO mice. The upregulation of nNOS and eNOS may compensate iNOS absence, explaining the similar bone healing outcome in WT and iNOS-KO strains.

Abstract This study aimed to evaluate the potential of strontium ranelate (SR) in medication-related jaw osteonecrosis (MRONJ) after tooth extraction in ovariectomized rats. Thirty ovariectomized rats were divided into three groups (n = 10): bisphophonate (BP) group (zoledronic acid; 0.4 mg/kg/week), SR group (625 mg/kg/day), and control group (saline solution). The lower first molars were extracted after 60 days of drug therapy. Drug administration was continued for another 30 days after tooth extraction. The mandibles were subjected to clinical, histological, radiographic, and microtomographic evaluations. Only the BP group showed clinical changes, characterized by the presence of 70% (n = 7) and 20% (n = 2) of ulcers and extraoral fistulas. Radiographic evaluation demonstrated bone sequestration only in the BP group (n = 7, 70%). Microtomographic analysis revealed increased bone porosity after ovariectomy, particularly in the the control group (p < 0.05). The BP group showed a higher bone surface density, bone volume, and trabecular number than SR and control groups, but with less trabecular separation (p < 0.05). All the animals in the BP group demonstrated histological osteonecrosis. There was no evidence of osteonecrosis in the control and SR groups, which was characterized by the absence of empty osteocyte gaps and associated with the gradual healing of the extraction area. Also, an increased number of blood vessels and a reduced number of osteoclasts were observed in the SR group (p < 0.05). Therefore, SR treatment increased angiogenesis and osteoclastogenesis in the healing socket and was not associated with MRONJ development after tooth extraction in ovariectomized rats.

RESUMO A Síndrome de Stevens Johnson (SSJ) e a Necrólise Epidérmica Tóxica (NET) são reações adversas, geralmente medicamentosas. Na pele, formam-se máculas que se tornam pápulas, vesículas e bolhas, além de eritema extenso e desprendimento da epiderme. As lesões bucais caracterizam-se pela presença de erosões e úlceras dolorosas. O tratamento geralmente é realizado em âmbito hospitalar, com necessidade de cuidados intensivos, onde o Cirurgião-dentista é fundamental na equipe multiprofissional, pois atuará na terapêutica das lesões bucais. Neste artigo foi relatado o caso de uma paciente do sexo feminino, de 26 anos, a qual apresentou lesões mucocutâneas compatíveis com NET associadas ao medicamento Fenitoína e necessitou de internamento em um Hospital Universitário. O tratamento realizado foi a suspensão imediata do fármaco desencadeador, além de terapia sistêmica com corticóide e imunossupressor. As lesões bucais foram acompanhadas pela equipe de odontologia hospitalar. As condutas adotadas foram: higiene bucal com solução de Digluconato de Clorexidina 0,12% não alcoólica, hidratação da mucosa bucal com Ácido Graxo Essencial, aplicação de raspas de chá de gelo de camomila e prescrição de Triancinolona Acetonida tópica. Além disso, foram realizadas sessões de laserterapia de baixa intensidade (vermelho e infravermelho). As lesões bucais evoluíram com melhora significativa. A paciente permaneceu internada durante 22 dias, sendo 12 em Unidade de Terapia Intensiva. Este caso demonstra a importância do Cirurgião-dentista na equipe multiprofissional. Apesar de não haver um protocolo para as lesões bucais, as condutas utilizadas no presente caso podem ser uma alternativa de terapêuticas utilizadas em lesões de SSJ e NET.

ABSTRACT Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are adverse reactions, usually medicine-related, in which extensive and painful mucocutaneous lesions are formed. Oral lesions are characterized by the presence of erosions and ulcers. The treatment usually requires intensive care in a hospital setting, where the Dentist is essential in the multidisciplinary team, as he will act in the treatment of oral lesions. In this article, a 26-year-old female patient was reported, who presented TEN-compatible mucocutaneous lesions associated with the drug Phenytoin and required admission to a Teaching Hospital. The treatment consisted of the immediate suspension of the Phenytoin use and systemic therapy with corticosteroids and immunosuppressants. Oral lesions were monitored by the hospital dentistry team. The procedures adopted were: oral hygiene with 0.12% non-alcoholic Chlorhexidine Digluconate solution, hydration of the oral tissue with an essential fatty acid, application of frozen chamomile tea, and prescription of topical Triamcinolone Acetonide. Also, low-level laser therapy sessions (red and infrared) were performed. Oral lesions evolved with significant improvement. In this case, the importance of the Dentist in the multi-professional team is demonstrated. Although there is no protocol, the procedures used in the present case can be an alternative to therapies used in SSJ and TEN oral lesions.

Resumo As opções limitadas para reparo ósseo levaram ao desenvolvimento de abrangente pesquisa na área de enxertos aloplásticos e xenogênicos. O objetivo deste estudo foi avaliar o reparo ósseo com dois substitutos ósseos: osso bovino desproteinizado (DBB) e cerâmica fosfática de cálcio bifásica (BCP) em defeito de tamanho crítico. Material e métodos: defeitos críticos de 8 mm foram feitos nos ossos parietais de coelhos (n=12). Os animais foram divididos em três grupos experimentais: sham (defeito preenchido com coágulo sanguíneo), DBB (defeito preenchido com DBB) e BCP (defeito preenchido com BCP). Após os períodos experimentais de 15 e 45 dias, os animais foram sacrificados e submetidos à análise histomorfométrica. Foram avaliadas a área total de defeitos, área de tecidos mineralizados, área de biomateriais e área de tecidos moles. Resultados: maior quantidade de tecido ósseo imaturo e de partículas de biomaterial foram observados no grupo BCP em comparação aos grupos DBB e sham aos 45 dias (p<0,05). Não houve diferença no padrão qualitativo de deposição óssea entre DBB e BCP. Ainda, o grupo sham não apresentou ilhas osteóides ao longo do defeito, apresentando maior quantidade de fibras colágenas em relação aos grupos DBB e BCP. Houve maior quantidade de células inflamatórias no DBB aos 45 dias em comparação aos grupos BCP e sham. Conclusões: BCP e DBB são opções para otimizar o uso de enxertos ósseos na reabilitação de pacientes. Defeitos ósseos tratados com BCP mostraram maior deposição de tecido ósseo aos 45 dias.

Abstract The limited options for bone repair have led to an extensive research of the field and the development of alloplastic and xenogeneic grafts. The purpose of this study was to evaluate bone repair with two bone substitutes: deproteinized bovine bone (DBB) and biphasic calcium phosphate ceramic (BCP) in critical-size defect. A total of 8-mm defects were made in the parietal bones of rabbits (n=12). The animals were divided into three experimental groups: sham (defect filled with a blood clot), DBB (defect filled with DBB), and BCP (defect filled with BCP). After the experimental periods of 15 and 45 days, the animals were euthanized and submitted to histomorphometric analysis. The total defect area, mineralized tissue area, biomaterial area, and soft tissue area were evaluated. A greater amount of immature bone tissue and biomaterial particles were observed in the BCP group compared to DBB and sham at 45 days (p<0.05). There was no difference in the qualitative pattern of bone deposition between DBB and BCP. However, the sham group did not show osteoid islands along with the defect, presenting a greater amount of collagen fibers as well in relation to the DBB and BCP groups. There was a greater number of inflammatory cells in the DBB at 45 days compared to BCP and sham groups. In conclusion, BCP and DBB are options for optimizing the use of bone grafts for maxillofacial rehabilitation. Bone defects treated with BCP showed greater deposition of bone tissue at 45 days.

Resumo O objetivo deste estudo foi avaliar o efeito da sepse aguda no ligamento periodontal, osso alveolar e osso da furca por meio de análise histológica e imunohistoquímica. O modelo de sepse em ratos foi estabelecido pelo procedimento de ligação e perfuração do ceco (CLP). Doze ratos foram divididos de forma randomizada em ratos sépticos (n=6) e controle - grupo Sham (n=6). Os animais foram eutanasiados após 24 horas e suas hemimandíbulas foram submetidas aos procedimentos histotécnicos para análise histomorfométricos (matriz óssea, fibras colágenas, fibroblastos, osteócitos, células inflamatórias e vasos sanguíneos) e imunohistoquímicos (BMP-2/4, RANKL e osteocalcina) no osso alveolar, osso de furca e ligamento periodontal. Nossos resultados demonstraram que os parâmetros histomorfométricos foram similares no osso alveolar, osso de furca e ligamento periodontal dos animais do grupo sepse e do grupo Sham. Em relação à análise por imunohistoquímica, o número de células imunomarcadas para BMP-2/4 e RANKL também foi similar em ambos os grupos. Entretanto, houve redução (p=0.0014) no número de células imunomarcadas para osteocalcina no ligamento periodontal de ratos sépticos em relação ao grupo Sham. Como conclusão, o estabelecimento de sepse aguda resultou em um número reduzido de células imunomarcadas para osteocalcina na região do ligamento periodontal (p=0,0014). Além disso, não foram observadas diferenças histológicas significativas no periodonto de ratos na presença de sepse aguda. Considerando o papel da osteocalcina na remodelação óssea, este estudo contribui para revelar a importância da avaliação periodontal cuidadosa na presença de sepse.

Abstract The aim of this study was to evaluate the effect of acute sepsis in the periodontal ligament, alveolar and furcation bone in absence of periodontitis induction through histological and immunohistochemical analyses. A septic rat model was established by cecal ligation and puncture (CLP). Twelve rats were randomly divided into CLP (n=6) and Sham (n=6) groups. The animals were euthanized at 24 h and hemimandibles were submitted to histomorfometric (bone matrix, collagenous fibers, fibroblasts, osteocytes, inflammatory cells, and blood vessels) and immunohistochemical (BMP-2/4, RANKL and osteocalcin) evaluation in alveolar bone, furcation bone and periodontal ligament. Our results demonstrated that histomorphometric parameters were similar in alveolar bone, furcation bone and periodontal ligament of Sham and CLP rats. Regarding to immunohistochemical analyses, the number of BMP-2/4 and RANKL immunolabeled cells was also similar in both groups. Furthermore, it was detected a reduction in the osteocalcin immunolabeled cells in periodontal ligaments of CLP compared to Sham rats (p=0.0014). In conclusion, the acute sepsis induction resulted in reduced number of osteocalcin labelled cells in periodontal ligament region. Moreover, no significant histological differences were observed in the periodontium of rats under acute sepsis. Considering the role of osteocalcin in bone remodeling, the study contributes to revealing the importance of careful periodontal evaluation in the presence of sepsis.

Resumo Introdução Hemorragias, edema no assoalho bucal e elevação da língua são complicações relacionadas a procedimentos cirúrgicos na região anterior da mandíbula. Objetivo Os objetivos deste estudo foram avaliar a presença e localização do forame lingual na região anterior da mandíbula e avaliar a morfologia mandibular utilizando tomografia computadorizada com feixe de cone (CBCT). Material e método A morfologia da mandíbula e a localização, diâmetro e altura do forame lingual foram analisados utilizando a medula e o forame mental como referências em 278 CBCT. Resultado 88% da amostra tinha um forame lingual da linha média, totalizando 408 forames, com um diâmetro médio de 0,93 mm. Na região lingual entre a linha média e forames mentais foram detectados em 75% da amostra, com um diâmetro médio de 0,807 mm. Não houve correlação positiva entre a presença de forames lingual nas regiões lateral ou na região média (r = -0,149; p = 0,013). Na região da linha média, a forma mandibular do tipo I era predominante (96%) e o tipo III predominava nas regiões laterais. Conclusão Considerando a prevalência dessas estruturas e sua relevância clínica em possíveis complicações cirúrgicas, é importante analisar cuidadosamente a região anterior da mandíbula durante o planejamento cirúrgico.

Abstract Background Hemorrhages, mouth floor edema and tongue elevation are complications related to surgical procedures in the anterior region of the mandible. Objective The objectives of this study were to evaluate the presence and location of the lingual foramen in the anterior region of the mandible and to evaluate mandibular morphology using cone beam computerized tomography (CBCT). Material and method The mandible’s morphology and the location, diameter and height of the lingual foramina were analyzed using the midline and the mental foramen as references, in 278 CBCT. Result 88% of the sample had a midline lingual foramen, totaling 408 foramina, with a mean diameter of 0.93 mm. Foramina in the lingual region between the midline and mental foramina were detected in 75% of the sample, with a mean diameter of 0.807 mm. There was no positive correlation between the presence of lingual foramina in the lateral or in the midline regions (r = -0.149; p = 0.013). In the midline region, the type I mandibular shape was predominant (96%), and type III was predominant in the lateral regions. Conclusion Considering the prevalence of these structures and their clinical relevance in potential surgical complications, it is important to carefully analyze the anterior region of the mandible during surgical planning.

Resumo Objetivo Avaliar o reparo ósseo associado ao uso da cerâmica bifásica a base de hidroxiapatita e β-tricálcio fosfato (HA/TCP) nos procedimentos de elevação da membrana do seio maxilar em humanos. Material e método Foram selecionados 10 pacientes com rebordo ósseo residual entre 3 mm e 5 mm de altura na região posterior da maxila e que tinham indicação para procedimentos de enxertia óssea associado ao levantamento de seio maxilar. Os seios maxilares foram preenchidos com HA/TCP, e após 8 meses, foi executado a instalação dos implantes e nesse momento foi realizada a coleta de um fragmento ósseo com auxílio de uma broca trefina, o qual foi submetido à análise histológica da área enxertada. Resultado A análise histológica das biópsias revelou a presença de tecido ósseo vital e imaturo, justaposto ao biomaterial. A análise histomorfométrica revelou percentuais de 28,8%, 27,4% e 43,6% para tecido ósseo, biomaterial e tecido mole, respectivamente. Conclusão As áreas enxertadas com a HA/TCP apresentaram quantidade adequada de formação óssea que permitiu a instalação dos implantes. O sucesso do procedimento de enxertia com esse biomaterial esteve associado ao seu potencial de osteocondução que permitiu a formação de tecido ósseo em íntimo contato com a HA/TCP.

Abstract Objective To evaluate the bone repair associated with the use of biphasic ceramics based on hydroxyapatite and β-tricalcium phosphate (HA/TCP) in the procedures of maxillary sinus membrane elevation in human beings. Material and method Ten patients with a residual bone ridge in the posterior maxillary region between 3 mm and 5 mm in height were selected and indicated for procedures of bone grafting associated with maxillary sinus lift procedure. The maxillary sinuses were filled with HA/TCP, and after 8 months, the implants were implanted and a bone biopsy was collected with the aid of a trephine drill, which was then submitted to histological analysis for the evaluation of the composition of the grafted area. Result The histological description analysis of the biopsies revealed the presence of vital and immature bone tissue, juxtaposed to the biomaterial. Histomorphometric analysis showed that the biopsy composition was in average 28.8%, 27.4%, and 43.6% of bone tissue, biomaterial, and soft tissue, respectively. Conclusion The areas grafted with HA/TCP presented the adequate amount of bone formation that allowed the implantation of the implants. The success of the grafting procedure with this biomaterial was associated with its osteoconduction potential that allowed the formation of bone tissue in close contact with HA/TCP.

RESUMO Introdução: os dispositivos de ancoragem temporária vêm sendo desenvolvidos para uso como coadjuvantes no tratamento ortodôntico. Esses dispositivos facilitam o tratamento ortodôntico de casos mais complexos, incluindo pacientes com dentes impactados. Objetivos: o presente relato de caso reporta a aplicabilidade dos dispositivos de ancoragem temporária no tratamento ortodôntico de um paciente com segundos molares inferiores impactados. Os procedimentos cirúrgicos e ortodônticos relacionados ao uso das miniplacas também são discutidos nesse estudo. Conclusões: o uso de dispositivos de ancoragem temporária, tais como as miniplacas, pode ser sugerido como uma alternativa no tratamento de pacientes com segundos molares inferiores impactados.

ABSTRACT Introduction: Temporary anchorage devices (TADs) have been developed to be used as direct adjuncts in orthodontic treatment and have facilitated treatment of more complex orthodontic cases, including patients with dental impaction. Objectives: This clinical case reports the applicability of TADs in the orthodontic treatment of a patient with impacted mandibular second molars. Surgical and orthodontic procedures related to the use of miniplates were also discussed in this study. Conclusions: The use of temporary anchorage devices, such as miniplates, can be suggested as an alternative to treat patients with impacted mandibular second molars.

Resumo: O objetivo deste estudo foi avaliar a estabilidade e osseointegração de implantes com superfícies com diferentes molhabilidades empregando análise de frequência de ressonância (RFA) e histomorfometria (contato implante ósseo, BIC, e fração de área óssea ocupada, BAFO), nos períodos de 2 e 4 semanas em tíbias de coelhos. Trinta e dois implantes cone Morse (comprimento 7mm, diâmetro 3,5 mm), foram divididos de acordo com tratamento de superfície (n = 8): Neo, superfície jateada e condicionada com ácido; e Aq, superfície jateada e condicionada com ácido e mantida em solução isotônica de cloreto de sódio a 0,9%. Dezesseis coelhos tipo Nova Zelândia foram utilizados neste estudo. Dois implantes de cada grupo foram instalados nas tíbias direita e esquerda de acordo com os períodos experimentais. Os valores de RFA (Ostell(r)) foram obtidos imediatamente e após o sacrifício (2 e 4 semanas). Os blocos ósseos/implante foram processados para análise histomorfométrica. Os dados foram analisados usando ANOVA fatorial seguido pelo teste de Tukey e também por meio de correlação de Pearson para os fatores RFA, BIC e BAFO (P=0,05). Nenhum efeito significativo dos fatores tipo de implante, período de avaliação e da interação entre o tipo de implante e período de avaliação foram observados para os valores de BIC e BAFO. Apenas o período de avaliação resultou em efeito significativo para valores RFA após 2 semanas (p=0,001), e 4 semanas (p<0,001). Os valores de RFA valores foram significativamente mais elevados no final do período de avaliação em comparação com os obtidos em inicialmente. Houve correlação significativa entre os valores BIC e BAFO (p=0,009). Ambas as superfícies de implantes, Aq e Neo, são capazes de produzir adequada integração osso/implante em condição normal de instrumentação do osso cortical.

Abstract: The aim of this study was to evaluate the stability and osseointegration of implant with different wettability using resonance frequency analysis (RFA) and histomorphometric analysis (bone implant contact, BIC; and bone area fraction occupied, BAFO) after 2 and 4 weeks in rabbit tibiae. Thirty-two Morse taper implants (length 7 mm, diameter 3.5 mm) were divided according to surface characteristics (n=8): Neo, sandblasted and dual acid-etched; and Aq, sandblasted followed by dual acid-etched and maintained in an isotonic solution of 0.9% sodium chloride. Sixteen New Zealand rabbits were used. Two implants of each group were installed in the right and left tibiae according to the experimental periods. The RFA (Ostell(r)) was obtained immediately and after the sacrifice (2 and 4 weeks). The bone/implant blocks were processed for histomorphometric analysis. Data were analyzed using two-way ANOVA followed by Tukey's test and Pearson's correlation for ISQ, BIC and BAFO parameters (p=0.05). No significant effect of implant, period of evaluation or interaction between implant and period of evaluation was found for BIC and BAFO values (p>0.05). Only period of evaluation had significant effect for RFA values at 4 weeks (p=0.001), and at 2 weeks (p<0.001). RFA values were significantly higher at the final period of evaluation compared with those obtained at early periods. There was a significant correlation between BIC values and BAFO values (p=0.009). Both implant surfaces, Aq and Neo, were able to produce similar implant bone integration when normal cortical bone instrumentation was performed.

Objective A study was conducted to investigate the possible influence of the single nucleotide polymorphism (SNP) IL-10-592 C/A on the occurrence and load of the periodontal pathogens: P. gingivalis, T. forsythia, T. denticolaand A. Actinomycetemcomitans; as well to investigate the influence of microbial and genetic factors on the modulation of local IL-10 mRNA levels. Methodology The study included 117 cases and 58 controls. After clinical examination microbiological samples were obtained and the detection/quantification of the target bacterial species was performed by RT-PCR. SNP rs1800872 was assayed by restriction fragment length polymorphism (RFLP). Results Allele distribution of rs1800872 was in Hardy-Weinberg equilibrium (P = 64). As previously reported, polymorphic subjects demonstrated decreased IL-10 expression and increased risk of suffering chronic periodontitis. IL-10-592C/A rs1800872 SNP was not associated with the detection or the bacterial load of the investigated pathogens. Moreover, the presence/load of bacteria at periodontal sites did not influence IL-10 expression, which was determined by the genetic background of the study subjects. IL-10-592C/A SNP was not associated with detection/bacterial load of pathogenic bacteria. IL-10 expression levels were determined by the genetic background and were independent of the bacterial microenvironment.

Objetivo Reportamos la asociación entre el polimorfismo de nucleótido simple de IL-10-592C/A (rs1800872) y la detección/abundancia relativa de los periodontopatógenos Porfiromonas gingivalis, Tenerella forsythia, Treponema denticola y Aggregatibacter actinomycetemcomitans. Además investigamos la influencia de los determinantes genéticos y microbiológicos en los niveles de expresión de IL-10 en lesiones periodontales. Metodología Fueron reclutados 117 pacientes con periodontitis crónica y 58 controles. Luego del examen clínico fueron obtenidas muestras microbiológicas y la presencia/carga bacteriana de especies de periodontopatógenos fue cuantificada por RT-PCR. El genotipo para IL-10-592C/A fue determinado mediante restriction fragment length polymorphism. Resultados La distribución alélica del SNP rs1800872 en la población investigada cumplió con el equilibrio de Hardy-Weinberg (p = 0,64). Como ya ha sido reportado, los sujetos polimórficos demostraron menor expresión de IL-10 y riesgo aumentado de sufrir periodontitis crónica. El polimorfismo IL-10-592C/A no demostró relación con la detección o carga bacteriana de ninguna de las bacterias investigadas, además los niveles de expresión de IL-10 no fueron influenciados por el perfil microbiológico, sino que se correlacionaron directamente con el genotipo para el polimorfismo IL-10-592C/A.

Periodontitis comprises a group of multifactorial diseases in which periodontopathogens accumulate in dental plaque and trigger host chronic inflammatory and immune responses against periodontal structures, which are determinant to the disease outcome. Although unusual cases of non-inflammatory destructive periodontal disease (NIDPD) are described, their pathogenesis remains unknown. A unique NIDPD case was investigated by clinical, microbiological, immunological and genetic tools. The patient, a non-smoking dental surgeon with excessive oral hygiene practice, presented a generalized bone resorption and tooth mobility, but not gingival inflammation or occlusion problems. No hematological, immunological or endocrine alterations were found. No periodontopathogens (A. actinomycetemcomitans, P. gingivalis, F. nucleatum and T. denticola) or viruses (HCMV, EBV-1 and HSV-1) were detected, along with levels of IL-1β and TNF-a in GCF compatible with healthy tissues. Conversely ALP, ACP and RANKL GCF levels were similar to diseased periodontal sites. Genetic investigation demonstrated that the patient carried some SNPs, as well HLA-DR4 (*0404) and HLA-B27 alleles, considered risk factors for bone loss. Then, a less vigorous and diminished frequency of toothbrushing was recommended to the patient, resulting in the arrest of alveolar bone loss, associated with the return of ALP, ACP and RANKL in GCF to normality levels. In conclusion, the unusual case presented here is compatible with the previous description of NIDPD, and the results that a possible combination of excessive force and frequency of mechanical stimulation with a potentially bone loss prone genotype could result in the alveolar bone loss seen in NIDPD.