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Inflammation-Driven Epithelial Plasticity in Oral Mucosa Adjacent to Long-Term Restorative Materials: A Retrospective
Roxana-Cristina Mehedinti1, Kamel Earar1,2, Ada Stefanescu1,2
1Medical and Pharmaceutical Research Center, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University of Galati, 800008 Galati, Romania.
Abstract:
Background and Objectives: Long-standing contact between oral mucosa and restorative materials may be associated with adaptive epithelial and stromal remodeling. This study evaluated non-dysplastic epithelial plasticity in the oral mucosa adjacent to long-term restorative materials. Materials and Methods: This retrospective study included 150 formalin-fixed, paraffin-embedded oral mucosal specimens divided into five groups: control, dental amalgam, methacrylate-based resin composite, clinically documented all-ceramic restorations, and metallic/metal-ceramic restorations (n = 30 each). Exposed cases had documented mucosal adjacency or repetitive contact with a dominant restorative material for at least 5 years. Histopathological parameters, CK19, Ki67, p53, and COX-2 expression were assessed, and MAERS was calculated. Statistical significance was set at p < 0.05. Results: MAERS differed significantly among groups (p < 0.001), with the highest mean values in metallic/metal-ceramic specimens (10.3 ± 2.4) and dental amalgam specimens (9.7 ± 2.1), intermediate values in resin composite specimens (7.1 ± 1.8), and the lowest values in all-ceramic (5.0 ± 1.4) and control specimens (4.8 ± 1.3). Suprabasal CK19 redistribution was observed in 22/30 metallic/metal-ceramic specimens (73.3%) and 20/30 amalgam specimens (66.7%), elevated Ki67 expression in 22/30 (73.3%) and 19/30 (63.3%), and moderate-to-strong COX-2 expression in 21/30 (70.0%) and 19/30 (63.3%), respectively. p53 expression was heterogeneous and did not show dominant, strong, or diffuse overexpression. Conclusions: Metallic/metal-ceramic restorations showed the highest remodeling burden, dental amalgam showed a similarly high profile, resin composite showed an intermediate profile, and all-ceramic-associated mucosa remained close to control specimens. These findings suggest material-dependent, inflammation-associated epithelial plasticity without evidence of epithelial dysplasia.
