Rom J Morphol Embryol 2015, 56(1):139147

ORIGINAL PAPER

RJME

Romanian Journal of
Morphology & Embryology
http://www.rjme.ro/

Cell populations involved in the processes of local mucosal

defense in extended partially edentulous and completely
edentulous patients. Clinical and immunohistochemical study
MONICA MIHAELA CRIOIU1), CLAUDIU MRGRITESCU2), ALMA FLORESCU1), ROXANA PASCU1),
ALINA MONICA PICO3), ANDREI PICO3), MARIANA SABU4), VASILE NICOLAE5)
1)
2)

Department of Prosthetic Dentistry, University of Medicine and Pharmacy of Craiova, Romania

Department of Pathology, University of Medicine and Pharmacy of Craiova, Romania

3)

Department of Prosthetic Dentistry, Iuliu Haieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

4)

Department of Occlusology, Lucian Blaga University of Sibiu, Romania

5)

Department of Oral Implantology, Lucian Blaga University of Sibiu, Romania

Abstract

Considering the fact that extended partial edentation and complete edentation have high incidence rates worldwide, the necessity for
correct prosthetic treatment is very important. We performed a clinical study on 37 extended partially edentulous patients and completely
edentulous patients, who were divided into three groups. We also performed a morphological study using classic techniques of histology
and immunohistochemistry methods on sections obtained from oral mucosa fragments collected from these patients and processed by
paraffin embedding technique. To identify the cell populations present in the inflammatory processes, we used the CD20, CD8, CD3 and
CD68 markers. In the studied cases, we found the presence of changes that have interested both the epithelium and lamina propria.
Epithelium showed in particular epithelial hyperplasia aspects, with orthokeratinization and parakeratinization areas and, in some sections, areas
of ulceration. We found the inflammatory process present in the lamina propria to be chronic and it consists in particular of lymphocytes,
plasma cells and macrophages. This process was differentiated in intensity from one case to another, but varied even within the same
case, from one area to another. Inflammation was determined by the local microbial flora enhanced by the action of prosthetic appliances
or by the prolonged edentulous state. We observed more intense changes in denture wearers patients. The inflammatory response indicates
the reactivity of the edentulous mucosa in response to local aggression, the specific defense mechanism coexisting with the nonspecific
defense mechanism, with predominance of cellular immune defense.
Keywords: edentulous patients, oral mucosa, immune cells, inflammatory processes.

Introduction
Extended partial edentation and complete edentation
have high incidence rates worldwide and the necessity for
correct prosthetic treatment for these patients is obvious.
The prosthetic therapy consisting of mobile partial and
complete dentures is largely used in daily dental practice
[1]. The mucosal component of the potential denture
bearing area is an important factor for a successful
prosthetic treatment.
The state of extended partial edentation and, especially,
complete edentation is the cause for morphological and
functional alterations of the potential denture bearing
area. Another contributing factor is represented by the
fact that the oral mucosa is a dynamic structure influenced
by systemic pathology and by associated local and general
therapy.
The prosthetic treatment of edentulous patients that
require mobile partial and complete dentures is an
important problem for the dental practice, as it plays a
major role for each patients quality of life [24]. The
therapeutic purpose is to replace the missing teeth and
bone with efficient dentures that respect the biological
and socio-cultural imperatives and that are easily integrated
by the patient [5]. Prosthetic rehabilitation is influenced
not only by the techniques and by the dental materials
ISSN (print) 12200522

used, but also by the quality of the mucosal substrate of the

potential denture bearing area, all these factors contributing
to an improved denture retention and stability.
The edentulous patient should be actively involved
in the denture treatment and should be aware of the
importance of acceptance of the prosthetic treatments
result the dentures. However, the existence of an
individual intellectual and physical limit of cooperation
has to be taken into consideration, as well as the presence
of certain general illnesses such as Parkinson, senility,
which causes oral mucosa dehydration, arthritis and
deafness, that complicate the prosthetic therapy [6, 7].
The morphological study of the mucosal component of
the potential denture bearing area of edentulous patients
not only is important, but is also necessary in the process
of elaborating the most favorable prosthetic treatment
plan. The prosthetic treatment of edentulous patients
should be the result of a comparative analysis of biofunctional advantages and disadvantages and it should
be individualized for each patient [8].
The purpose of this study is to analyze the correlations
between macroscopic and microscopic (histological and
immunohistochemical) aspects of the oral mucosa of the
potential denture bearing area in extended partially
edentulous and completely edentulous patients.
ISSN (on-line) 20668279

Monica Mihaela Crioiu et al.

140

Materials and Methods

We conducted, in parallel, a clinical study and a
morphological study, using both classic techniques of
histology and immunohistochemistry methods.
Clinical study
Patients involved in this study were selected during
the period May 2014September 2014 from the patients
of the Prosthetic Dentistry Clinic of the Faculty of Dental
Medicine, University of Medicine and Pharmacy of Craiova,
Romania. The total number of patients was 37, both men
and women aged 52 to 79 years. Twenty-two were extended
partially edentulous patients and 15 were completely
edentulous patients. We obtained the informed consent
from all the patients included in this study.
The patients were divided into the following groups:
the first group consisted of 15 extended partially edentulous patients and completely edentulous patients, without
alterations of the oral mucosa of the potential denture
bearing area; the second group was formed of eight
extended partially edentulous and completely edentulous
patients with alterations of the oral mucosa of the potential
denture bearing area (such as traumatic injuries, congestive
alterations of the oral mucosa, oral mucosal hyperplasia),
who were never denture wearers before; the third group
consisted of 14 extended partially edentulous and completely edentulous patients, denture wearers, with alterations of the oral mucosa of the denture bearing area
(such as congestive alterations of the oral mucosa, oral
mucosal hyperplasia, flabby ridge, denture stomatitis).
The patients were clinically examined. Fragments of
oral mucosa were collected from these patients from
different areas of the potential denture bearing area, during
teeth extractions that we performed in the cases where
the clinical situation required them or by excision of oral
mucosal areas presenting macroscopic clinical changes
represented by oral mucosal hyperplasia and flabby ridge.
The patients were presented with prosthetic treatment

options that took into consideration the existing mucosal

characteristics of each clinical case.
Histological processing
The excised oral mucosa fragments were fixed in 10%
formalin for 4872 hours and then processed by conventional histological techniques for paraffin embedding.
The paraffin blocks were sectioned with the Microm
HM325 microtome and 4 m sections were obtained
and stained with HematoxylinEosin (HE), Goldner
Szekely (GS) trichrome, Van Gieson (VG) trichrome,
Periodic Acid Schiff (PAS).
Immunohistochemical processing
After histological analysis, we selected sections from
the initial three groups. These sections were processed
for immunohistochemical study. Immunohistochemical
analysis was performed on 4 m thick serial sections,
applied to slides treated with adhesive poly-L-Lysine.
The sections were dried for 12 hours at laboratory temperature, after which they were dewaxed in three successive
baths of xylene (15 minutes for each bath). This was
followed by rehydration through successive passage of
the sections through four alcohol baths with decreasing
concentrations (100% alcohol, 96% alcohol, 80% alcohol,
70% alcohol), for approximately 10 minutes per each bath.
Finally, sections were passed through distilled water to
remove any trace of alcohol. For the immunohistochemical
study, the LSAB2 technique was used as a working
method (StreptavidinBiotin 2 Labeled System). The kit
we used was manufactured by Dako, Redox, Romania.
The result of these immunohistochemical reactions is to
visualize the investigated antigens with 3,3-diaminobenzidine (DAB) (Dako, Redox, Romania) by brown
staining. Mayers Hematoxylin was used for counterstaining.
Negative controls were obtained by omitting the primary
antibodies, and as external positive control were used
normal oral mucosa specimens.
The antibodies used in this study are listed in Table 1.

Table 1 Antibodies used in the immunohistochemical study

Antibody

Code

Clone

Specificity

Antigen retrieval

Dilution

Source

CD20
CD8
CD3
CD68

M0755
IS623
A0452
M0814

L26
144B
F7.2.38
KP1

B-lymphocytes
T-lymphocytes
T-lymphocytes
Macrophages

Sodium citrate buffer, pH 6

Sodium citrate buffer, pH 6
Sodium citrate buffer, pH 6
Sodium citrate buffer, pH 6

1:100
1:200
1:100
1:200

Dako
Dako
Dako
Dako

Images were taken using a Nikon Eclipse 55i Research

microscope (Nikon, Apidrag, Mumbai) equipped with
Plan Fluor objective, DS-Fil digital camera with 5 megapixel resolution, acquisition board, acquisition and Nikon
NIS-Elements imaging analysis software.
Quantification of immunohistochemical expression was
made using the criteria utilized by literature [9]: (-) negative
staining; () reduced staining; (+) weak staining, very
focal, visible only at high magnification; (++) focal
staining of moderate intensity, visible to the average
increase; (+++) intense positive staining clearly visible
at low magnification.
Results
Through microscopic examination, we have highlighted
different aspects depending on the existing clinical

situation of the patient: partially edentulous patients and

completely edentulous patients who were not wearers of
removable dentures, with or without modification of the
oral mucosa, and patients that were wearers of removable
dentures and that also had obvious clinical oral mucosa
modifications.
On all of the examined sections, we found changes
that have interested both epithelium and lamina propria,
but that vary in intensity depending on the presence and
type of previous prosthetic therapy and on the clinical
status of patients (associated systemic pathology). Structural
changes were varied, both at the epithelia level and in the
lamina propria and were due to local factors and individual
factors. We found the most important modifications on
sections from patients who had clinical macroscopic
mucosal changes, as well as on sections from patients
with a preexistent removable prosthetic therapy and on

Cell populations involved in the processes of local mucosal defense in extended partially edentulous and completely

sections from elderly patients who presented associated

pathology (diabetes, cardiovascular disease). Thus, the
mucosal morphology of the denture bearing area of
edentulous patients is subjected to the action of a plurality of local factors (the presence or the absence of prosthetic restorations and their type) and of general factors
(age, genetic factors, nutritional factors, systemic and
local associated pathology).
Histological aspects
The microscopic examination has highlighted different
aspects depending on the existing clinical situation of the
patient: partially edentulous patients or completely edentulous patients, who had never been denture wearers, with
or without modification of the oral mucosa and denture
wearers patients with obvious clinical changes.
We found changes in all the patients, changes that
have interested both epithelium and lamina propria, but
that vary in intensity depending on the presence and on the
type of previous prosthetic treatment. Structural changes
varied, both at epithelial level and in the lamina propria
and were due to local factors and individual factors. We
encountered the most important changes on sections from
patients who had clinical macroscopic mucosal alterations,
as well as on sections from denture wearers patients and
from elderly patients with a history of medical problems
(diabetes, cardiovascular disease).
We frequently encountered hyperplasia at the level
of the coverage epithelium with deep epithelial ridges
(Figure 1, AC). The epithelium presented intense keratinization areas (Figure 1, B and C) and discrete or even
absent keratinization areas. The most present was the
orthokeratinization process, while the parakeratinization
process was rarely encountered. In some sections, keratinization areas were located only in the tip of the edentulous ridge mucosa.
We encountered acanthosis-like alterations, of different
intensity with increase in epithelium thickness due to
hyperplasia of the stratum spinosum cells (Figure 1A).
On sections from some of the patients, the papillomatosis
associated with orthokeratosis or parakeratosis and acanthosis was identified only in reduced areas. On sections
from patients who were clinically identified with ulcerative
lesions, the epithelium showed areas of discontinuity, at
this level the connective tissue being in direct contact
with the oral environment. In other cases, the epithelium
was atrophic, characterized by reducing or deleting the
epithelial ridges (Figure 1D), associated with acanthosis
areas.
Local factors, determined by the prosthetic treatment
and individual factors have caused changes in fibers,
cells and vessels of the lamina propria. In lamina propria,
we found the presence of an inflammatory process with
an intensity that varied from one case to another and, in
the same section, from one area to another. It is either
diffuse (Figure 1, D and E) or subepithelially and perivasculary located (Figure 1F). Most often, the inflammatory infiltrate is represented by lymphocytes and plasma
cells, which suggest a chronic inflammatory process. The
inflammatory process causes a stimulation of fibrillogenesis, fibroblasts being present in high numbers. Fibrillary
component is quantitatively modified by the increased
number of fibers, as well as qualitatively altered, the fibers
being fragmented or having irregular paths. Sometimes,

141

fibrillar component is disposed around areas with inflammatory infiltrate that they encircle and delineate (Figure 1E).
Numerous blood vessels are present, especially near the
inflammatory process area. The presence of numerous
neoformation blood vessels was observed on sections
obtained from patients who had old dentures. The vessels
had sometimes parietal changes that have led to hematic
extravasation and microhemorrhages. Sometimes, we
identified the presence of polymorphonuclear neutrophils,
which indicate the flare-up of the chronic inflammatory
process.
Immunohistochemical aspects
On oral mucosa sections processed by paraffinembedding technique, we identified the cell populations
present in the inflammatory processes. We used the
following markers: CD20, CD8, CD3, and CD68.
Evaluation of CD20 immunoexpression

We used anti-CD20 antibody to highlight specific Blymphocytes. We identified relatively few lymphocytes
in the inflammatory infiltrate present in the sections
examined as compared to other cell types. Their distribution was uneven, as they were present mainly around
blood vessels and around proliferated epithelial ridge
(Figure 2, CE). Localization of B-lymphocytes around
blood vessels suggests that antigens present in the lamina
propria, resulted from the external environment or from
the damage resulting from its own structures, stimulate
their passage from the blood capillaries. In most cases, Blymphocytes had a diffuse location (Figure 2, A and B),
sometimes they were grouped as small outbreaks, having
a pseudofolliculary aspect (Figure 2F).
On sections from patients with clinical ulcerative
lesions, we encountered a greater number of B-lymphocytes, in the epithelium and in the connective tissue.
This is due to discontinuities in the epithelium that favor
the passage of antigens from the oral environment through
the affected epithelial barrier.
Evaluation of CD8 and CD3 immunoexpression

In the areas with lymphocytic infiltration, we have

shown the presence of T-lymphocytes using CD8 (a
marker for cytotoxic T-lymphocytes) and CD3 (pan-T
marker) immunomarkers. T-lymphocytes showed a subepithelial arrangement, particularly in lamina propria and a
perivascular arrangement (Figure 3, B, C, E and F). In
addition, lymphocytes have been identified among the
bundles of collagen fibers (Figure 3A) and at intraepithelial level, in the cases that presented ulceration of the
oral mucosa. Lymphocytic infiltrate was either diffuse
or had a pseudofollicular aspect (Figure 3D). Cytotoxic
T-lymphocytes were present in an increased number,
especially in the ulcerated mucosal areas and perivascularly. T-lymphocytes were predominant in all sections
examined, indicating a cellular immune defense process.
Non-uniform distribution of T-lymphocytes is determined
by the zonal presence of antigens.
Evaluation of CD68 immunoexpression

With the help of CD68 antibody, macrophages participating in the local defense process were evidentiated.
We noticed the different distribution of macrophages in
the lamina propria. In some areas of the oral mucosa, we

142

Monica Mihaela Crioiu et al.

observed the presence of macrophages in the form of

groups (Figure 4F). Sometimes, their arrangement was
diffuse, adjacent to epithelial proliferations areas (Figure 4,
AC), in epithelium areas with erosion, among bundles
of connective fibers, around blood vessels (Figure 4, D
and E). The intensity of the inflammatory process, and

thus macrophages density differs from one case to

another, but there were regional differences within the
same case, too. Macrophage infiltration intensity was
higher in edentulous patients who were denture wearers.
We also noticed clusters of macrophages in epithelial
ulceration mucosal areas.

Figure 1 (A) Epithelial hyperplasia with deep epithelial ridges, subepithelial inflammatory infiltrate and numerous
blood capillaries. HE staining, 200; (B) Papillomatosis, mild acanthosis, parakeratosis and the development of fibrillar
collagen component in lamina propria. VG trichrome staining, 200; (C) Epithelium with deep-branched epithelial
ridges, with acanthosis and orthokeratinization areas; (D) Atrophic epithelium with inflammatory infiltrate in lamina
propria. HE staining, 200; (E) Subepithelial and perivascular lymphocytic inflammatory infiltrate. GS trichrome
staining, 200; (F) Perivasculary inflammatory infiltrate, numerous fibroblasts and an intense collagen fibrillogenesis
process. HE staining, 200.

Cell populations involved in the processes of local mucosal defense in extended partially edentulous and completely

143

Figure 2 Immunoreactivity for CD20: (A and B) Diffuse lymphocytic infiltrate with B-lymphocytes CD20+ deeply in
lamina propria, 200; (C and D) Inflammatory infiltrate with rare B-cells CD20+ adjacent to epithelial proliferations
and one intraepithelial B-lymphocyte, 200; (E) Diffuse infiltrate of B-lymphocytes CD20+ adjacent to elongated
epithelial ridges, 100; (F) Pseudofollicular infiltrate with rare B-lymphocytes CD20+ delimited by thick bands of
collagen fibers, 200.

144

Monica Mihaela Crioiu et al.

Figure 3 Immunoreactivity for CD8 and CD3: (A) Diffuse lymphocytic infiltrate with rare T-lymphocytes CD8+
arranged among bundles of collagen fibers from lamina propria, 200; (B) Rare T-lymphocytes CD8+ diffusely
arranged in the chorion of epithelial ridges, 200; (C) Dense perivascular lymphocytic infiltrate with rare Tlymphocytes CD8+ in lamina propria, 200; (D) Pseudofollicular lymphocytic infiltrate through bundles of collagen
fibers in lamina propria, with rare T-lymphocytes CD8+, 200; (E) Subepithelial cell infiltrate of T-lymphocytes
CD3+, 100; (F) Abundant inflammatory infiltrate, T-lymphocytes, in an area presenting surface epithelial erosion
CD8+, 100.

Cell populations involved in the processes of local mucosal defense in extended partially edentulous and completely

145

Figure 4 Immunoreactivity for CD68: (AC) Diffuse inflammatory infiltrate disposed at the interface of epithelial
proliferations with rare macrophages CD68+, 200; (D and E) Diffuse inflammatory infiltrate disposed through
bundles of collagen fibers of lamina propria, with rare and isolated macrophages CD68+, 200; (F) Pseudofollicular
inflammatory infiltrate with rare macrophages, most being disposed peripherally CD68+, 200.

Discussion
Correct evaluation of edentulous patients oral mucosal
substrate, denture wearers or not, requires not only a
thorough clinical examination, but it especially requires
a histological examination on the basis of morphological
criteria which can lead, in conjunction with clinical data, to
a diagnosis of certainty. Optimal therapeutic solution,
including the impression taking method and the pros-

thetic treatment solution must be the result of a critical

evaluation, which takes into consideration a tripod
represented by: the general health condition of the
patient (including associated pathologies), the state of
edentulism and structural characteristics of the oral
mucosa and its pathological alterations. The structural
substrate at the prosthodontists disposal is the one that
dictates the adequate prosthetic conduct in order to
achieve functional prosthetic restorations and to ensure

146

Monica Mihaela Crioiu et al.

adequate nutrition of the oral mucosa for as long as

possible. The diagnosis and treatment strategies should
be individualized.
Through this approach, the study that we conducted
brought a double contribution for both basic research
and for the clinical research, the two sides influencing
each other. The basic research, centered on studying
edentulous patients, mucosal substrate enables the
assessment of etiopathogenic mechanisms involving the
inflammatory process and especially involving a certain
type of local defense: specific immune-type defense,
or non-specific macrophage-type defense.
In the studied cases, we found the presence of changes
that have interested both the epithelium and lamina
propria. Epithelium showed in particular epithelial hyperplasia aspects, with orthokeratinization and parakeratinization areas. Very rarely, in the cases of two edentulous
patients, epithelium presented dysplastic aspects, which
indicate that a chronic aggression can induce major
changes in the mucosa. Epithelium presented, in some
sections, areas of ulceration. These issues were recorded
in the cases of denture wearers edentulous patients.
Epithelial changes result from actions of several local
factors: the bacterial flora, vascularization disorders,
mechanical factors [10].
The inflammatory process present in the lamina propria
is chronic and consists in particular of lymphocytes, plasma
cells and macrophages. This process was differentiated
in intensity from one case to another, but varied even
within the same case, from one area to another. Inflammation was determined by the local microbial flora
enhanced by the action of prosthetic appliances or by
the prolonged edentulous state.
The presence of lymphocytic inflammatory infiltrate
shows the existence of a local specific (immune) defense
process and of a non-specific (macrophages) defense
process. Immunohistochemical study of cell populations
involved in the inflammatory process of the oral mucosa
of edentulous patients shows a significant reactivity of
the edentulous territory under the action of various, both
local and general, aggression factors [1113]. Immune
response seen in sections from all the studied cases was
predominantly cellular, but also associated a humoral
immune response. Intraepithelial presence of CD8-positive
lymphocytes (cytotoxic) in the ulcers sections of oral
mucosa, confirm their cytotoxic effect at this level.
Oral mucosal epithelium has immense importance in
local defense and in alerting the immune system, as it
is the first tissue structure originally facing with most
microorganisms in the oral cavity. Interrelation between
oral mucosal epithelium and immune system is essential
because this is where is the difference between commensally
flora and pathogenic flora is made and cellular and
humoral mechanisms for maintaining local homeostasis
are activated [14]. Initially, it was thought that the
epithelium is only a passive barrier against invading
pathogens, but relatively recent studies have shown that
epithelial cells are capable of eliciting an immune response,
thus playing an active role in microbial recognition.
Therefore, the oral epithelium is able to secrete a variety
of defense effector molecules [15] and to orchestrate an
immune inflammatory response in order to activate

immune cells in the lamina propria that destroy invading

pathogens [16].
Immune responses to food antigens and commensally
bacteria generally do not cause any inflammation and do
not induce immune tolerance [17]. However, the oral
mucosa is the seat of severe inflammatory or autoimmune
diseases, such as periodontitis, Sjgrens syndrome and
oral lichen planus. In these cases, there is a more or less
extensive destruction of the gingival barrier with gingival
epithelial necrosis, including the basal layer, and massive
infiltration of the lamina propria with lymphocytes, macrophages and polymorphonuclears [18, 19].
Neutrophils are essential cells in oral mucosal immune
defense and in maintaining normal oral biofilm. They
capture and destroy microbial agents by phagocytosis, the
process by which microbes are internalized and digested
in phagolysosomes. Some of neutrophils that reach the
surface of the oral epithelium degranulate and release
reactive bactericidal oxygen species (ROS) [20, 21].
In pathological situations, neutrophils are recruited
to the site of invasion of pathogenic agents by a variety
of potent chemoattractants such as interleukin 8 (IL8),
the fragment C5a and other chemokines [22, 23]. In
these places, they are intensifying phagocytosis and the
release of ROS.
Cells of the immune defense system release, at lamina
propria level, growth factors that induce fibroblast
presence in large numbers. The higher number of fibrocytes encountered is a reactivation of these cells, that,
through an increased fibrilogenetic process conduct a
reparative response, limiting the inflammatory process
and restoring local homeostasis. Fibroblasts stimulation
is determined by fibroblast growth factors secreted by
bacteria or by the cells of the immune system, as shown
also by literature.
Different types of cells that are present cooperate,
influencing one another, in order to restore normal
functionality. The activity of macrophages is enhanced
due to lymphokines synthesized by T-lymphocytes that
are present in large numbers in the inflammatory process.
Also, present on the examined sections, high number
of capillaries, vasodilatation, stasis and microbleedings
are the effect of chemical mediators that are released in
the inflammatory areas or may be of mechanical nature
as in the case of denture wearers. Intense vascularization supports the specific and non-specific defense
process, by increasing exchanges between blood and
tissue. The presence of a large number of localized subepithelial capillaries is motivated by the increased needs
of an epithelium in proliferation (acanthotic epithelium).
More intense changes were observed in patients who
were denture wearers. It may be possible that mechanical
forces that are beyond the means of local adaptation
possibilities induce the inflammatory reactions that we
observed in the lamina propria. Thus, inflammation is
the response to local aggression.
Conclusions
Oral mucosal alterations interest, in different proportions, all the structural components: epithelium, basement
membrane, lamina propria. These alterations differ from
one patient to another and they are influenced by the

Cell populations involved in the processes of local mucosal defense in extended partially edentulous and completely

existence of previous prosthetic treatment and by the

type of the previous prosthetic therapy. The results of the
histological examination of the oral mucosa of edentulous
patients corroborated with data from clinical examination
are important both for basic research, helping to deepen
the understanding of the local pathogenic mechanisms,
as well as for clinical prosthetic practice, offering the
possibility of individualized prosthetic treatment. The
inflammatory response indicates the reactivity of the
edentulous mucosa in response to local aggression, the
specific defense mechanism coexisting with the nonspecific defense mechanism, with predominance of cellular
immune defense, in order to restore local homeostasis.
Conflict of interests
The authors declare that they have no conflict of
interests.
Acknowledgments
This paper was published under the frame of European
Social Found, Human Resources Development Operational
Programme 20072013, Project No. POSDRU/159/1.5/
S/136893.
References
[1] Wstmann B, Budtz-Jrgensen E, Jepson N, Mushimoto E,
Palmqvist S, Sofou A, Owall B. Indications for removable
partial dentures: a literature review. Int J Prosthodont, 2005,
18(2):139145.
[2] Celebi A, Knezovi-Zlatari D. A comparison of patients
satisfaction between complete and partial removable denture
wearers. J Dent, 2003, 31(7):445451.
[3] Graham R, Mihaylov S, Jepson N, Allen PF, Bond S. Determining need for a removable partial denture: a qualitative
study of factors that influence dentist provision and patient
use. Br Dent J, 2006, 200(3):155158, discussion 147.
[4] Wolfart S, Heydecke G, Luthardt RG, Marr B, Freesmeyer WB,
Stark H, Wstmann B, Mundt T, Pospiech P, Jahn F, Gitt I,
Schdler M, Aggstaller H, Talebpur F, Busche E, Bell M.
Effects of prosthetic treatment for shortened dental arches
on oral health-related quality of life, self-reports of pain and
jaw disability: results from the pilot-phase of a randomized
multicentre trial. J Oral Rehabil, 2005, 32(11):815822.
[5] Pompignoli M, Doukhan JY, Raux D. Prothse complte.
e
Clinique et laboratoire. 4 edition, ditions CdP, Wolters
Kluver, France, 2011, 121.

147

[6] Emami E, Allison PJ, de Grandmont P, Rompr PH, Feine JS.

Better oral health related quality of life: type of prosthesis or
psychological robustness? J Dent, 2010, 38(3):232236.
[7] Sondell K, Sderfeldt B, Palmqvist S. Dentist-patient communication and patient satisfaction in prosthetic dentistry. Int J
Prosthodont, 2002, 15(1):2837.
[8] Klages U, Esch M, Wehrbein H. Oral health impact in patients
wearing removable prostheses: relations to somatization,
pain sensitivity, and body consciousness. Int J Prosthodont,
2005, 18(2):106111.
[9] Jasani B, Schmidt KW. Immunohistochemistry in diagnostic
pathology. Churchill Livingstone, Edinburgh, 1993, 125140.
[10] Zurac S, Girtan M, Lavric L, Petsakos G, Stniceanu F,
Bastian A, Andrei R, Popp C, Laba E. Local immune alterations
in oral mucosa of the edentulous patients; possible cause of
teeth loss? Rom J Intern Med, 2008, 46(3):249253.
[11] Walker DM. Oral mucosal immunology: an overview. Ann
Acad Med Singapore, 2004, 33(4 Suppl):2730.
[12] Taylor TD, Morton TH Jr. Ulcerative lesions of the palate
associated with removable partial denture castings. J Prosthet
Dent, 1991, 66(2):213221.
[13] Coelho CM, Zucoloto S, Lopes RA. Denture-induced fibrous
inflammatory hyperplasia: a retrospective study in a school
of dentistry. Int J Prosthodont, 2000, 13(2):148151.
[14] Weindl G, Wagener J, Schaller M. Epithelial cells and innate
antifungal defense. J Dent Res, 2010, 89(7):666675.
[15] Diamond G, Beckloff N, Ryan LK. Host defense peptides
in the oral cavity and the lung: similarities and differences.
J Dent Res, 2008, 87(10):915927.
[16] Cutler CW, Jotwani R. Dendritic cells at the oral mucosal
interface. J Dent Res, 2006, 85(8):678689.
[17] Wu RQ, Zhang DF, Tu E, Chen QM, Chen W. The mucosal
immune system in the oral cavity an orchestra of T cell
diversity. Int J Oral Sci, 2014, 6(3):125132.
[18] Cochran DL. Inflammation and bone loss in periodontal
disease. J Periodontol, 2008, 79(8 Suppl):15691576.
[19] Scully C, Carrozzo M. Oral mucosal disease: lichen planus.
Br J Oral Maxillofac Surg, 2008, 46(1):1521.
[20] Nordenfelt P, Tapper H. Phagosome dynamics during phagocytosis by neutrophils. J Leukoc Biol, 2011, 90(2):271284.
[21] Hirschfeld J. Dynamic interactions of neutrophils and biofilms.
J Oral Microbiol, 2014, 6:26102.
[22] Lin F, Nguyen CM, Wang SJ, Saadi W, Gross SP, Jeon NL.
Effective neutrophil chemotaxis is strongly influenced by mean
IL-8 concentration. Biochem Biophys Res Commun, 2004,
319(2):576581.
[23] Sarma JV, Ward PA. New developments in C5a receptor
signaling. Cell Health Cytoskelet, 2012, 4:7382.

Corresponding author
Monica Mihaela Crioiu, Lecturer, MD, PhD, Department of Prosthetic Dentistry, Faculty of Dental Medicine,
University of Medicine and Pharmacy of Craiova, 2 Petru Rare Street, 200349 Craiova, Romania; Phone +40723
629595, e-mail: mcraitoiu@yahoo.com

Received: October 28, 2014

Accepted: March 12, 2015