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2017 Mar-Apr;21(2):160-3. 2017 Nov;28(11):1354-9. Development of periodontitis is also affected by other intrinsic (eg, genetics, tooth crowding, thin alveolar bone, age) and extrinsic (eg, diet, stress, concurrent disease, oral hygiene) factors. American Academy of Periodontology. Statistical analyses were performed by statistician from the University of Brescia. J Indian Soc Periodontol. Leow NM, Moreno F, Marletta D, et al. The Merck Veterinary Manual was first published in 1955 as a service to the community. Methods: Twenty-four patients with stage IV/grade C periodontitis who received combined periodontal and orthodontic treatment were included in this study. Newman MG, Takei HH. This treatment of periodontal disease can be non-surgical or surgical with the optimal treatment being based on individual patient, site, and systemic factors. Younes, R.; Ghorra, C.; Khalife, S.; Igondjo-Tchen-Changotade, S.; Yousfi, M.; Willig, C.; Senni, K.; Godeau, G.; Naaman, N. Pertinent cell population to characterize periodontal disease. Staging and Grading of Periodontitis: Setting Standards for Use in J Dent (Shiraz). Multiple external root resorptions in a patient with Stage IV, Grade C Some dogs and cats may not allow regular toothbrushing, so the plaque should be removed by wiping with a gauze pad at least every second or third day. ; Michalowicz, B.S. Quantitative analysis of the percentage of inflammatory cells and the vascular area were performed using a camera equipped with an image analysis system (Image-Pro Premier 9.1; Immagini e Computer, Milan, Italy). Generalized stage IV, grade C periodontitis results in rapid bone destruction in the periodontium and can lead to early tooth loss. Click to reveal Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive Periodontitis presents differently for everybody. Periodontal diseases. F: 904-249-8554, 1409 Kingsley Avenue, Suite 9A, -, Pihlstrom B.L., Michalowicz B.S., Johnson N.W. 2021 Mar;106:103562. doi: 10.1016/j.jdent.2020.103562. If the gingivitis does not resolve, further examination should be performed to identify additional complicating conditions such as persistent subgingival plaque and calculus or the presence of predisposing factor(s). generalized). Dementias: Periodontitis and periodontal pathogens have been associated with dementias and Alzheimers Disease. Maxillary sinus floor elevation using the (transalveolar) osteotome technique with or without grafting material. Plaque is a typical biofilm, composed of many microorganisms that differ from their planktonic forms. Get Directions 0000056826 00000 n Its effect contributes to the histopathological alteration, possibly worsening the clinical periodontal condition. eCollection 2023. analyzed the data; L.R. A stage 3 mobility is present when tooth mobility is increased in any direction other than axial over a distance >1 mm or any axial movement. A systematic review. 0000131229 00000 n Lost bone may be augmented by use of bone grafts or bone graft substitutes. F: 904-398-1810, 9432 Baymeadows Road, Suite 200, This is achieved through professional dental cleaning (scaling and polishing) with power and hand instruments under general anesthesia. Meyle J., Chapple I. Molecular aspects of the pathogenesis of periodontitis. J Periodontol. Visit our dedicated information section to learn more about MDPI. 8600 Rockville Pike Unable to load your collection due to an error, Unable to load your delegates due to an error. HHS Vulnerability Disclosure, Help 4.2 Sequence for the treatment of stage IV periodontitis. Teughels W, Dhondt R, Dekeyser C, Quirynen M. Treatment of aggressive periodontitis. This treatment of periodontal disease can be non-surgical or surgical with the optimal treatment being based on individual patient, site, and systemic factors. Correction of anatomic conditions that predispose the patient to periodontitis, impair aesthetics, or impede placement of prosthetic appliances, Extraction of teeth that cannot be successfully treated, Placement of implants when teeth are lost. Systemic antibiotics in the treatment of aggressive periodontitis. https://doi.org/10.3390/biomedicines7020043, Subscribe to receive issue release notifications and newsletters from MDPI journals, You can make submissions to other journals. Next, your periodontist will assess the rate of progression (Grade A, B, and C) for their specific patient. Periodontitis Stage III-IV, Grade C and Correlated Factors: A Results: Al-Zahrani, M. S., Alhassani, A. Methods: Eighteen subjects with GPIIIIVC were enrolled in this study. Scaling and root planing (SRP) complemented by systemic antibiotics, access surgery, regenerative techniques and implant placement are among the treatments used for patients with this condition. Extraction treatment on orthodontic patients with Stage /Grade C 2022 Dec 10;10(12):2505. doi: 10.3390/healthcare10122505. New and exciting things were happening at this past EuroPerio9 held in Amsterdam from June 20th-23rd, 2018. Periodontal disease is a chronic infection that can result in the destruction of tooth-supporting structures (i.e., the gingiva, periodontal ligament, and/or alveolar bone) and eventual tooth loss.6, According to analysis of data from the National Health and Nutrition Examination Survey (NHANES) collected from 2009 to 2014, roughly 42% of dentate adults 30 years of age or older in the United States have some form of periodontitis (mild, moderate or severe).7 The prevalence of periodontitis increases with age; it is significantly more common in males than in females, and in non-Hispanic Blacks and Hispanics than non-Hispanic whites.7. Root scaling (removing plaque and calculus on exposed root surfaces) and planing (smoothing the root surfaces by removing textural irregularities and diseased cementum) are performed, followed by gingival curettage that removes the infected and inflamed inside layer of a periodontal pocket. Now that the charts are available, implementation into schools, clinics, and private practices can occur. An official website of the United States government. Performance & security by Cloudflare. 0000101987 00000 n ; E.S. The guidelines can be followed so consistent diagnosing can occur. The AAP released two documents titled Three Steps to Staging and Grading a Patient and Staging and Grading Periodontitis. A quick synopsis of the three stages are as follows; Step 1: Initial Case Overview to Assess Disease, the recommendation is to conduct a screening consisting of radiographs, probing depths, and missing teeth. 2.1 Target users of the guideline. Materials and methods: The worst periodontal condition is evident in patients with generalized stage III-IV, grade C periodontitis. In 2018, the American Academy of Periodontology and the European Federation of Periodontology published the World Workshop Classification System for Periodontal and Peri-Implant Diseases and Conditions, which established a new approach to diagnosing periodontal disease to replace the system developed in 1999. The percentage of inflammatory cells and the vascular area were measured and evaluated in relation to each periodontal disease-associated factor. ; Papapanou, P.N. Published by John Wiley & Sons Ltd. Written informed consent was obtained from all patients. 2021 Dec;120(12):2072-2088. doi: 10.1016/j.jfma.2021.06.029. 2022 John Wiley & Sons A/S. Jepsen K, Jerve-Storm PM, Henrichs I, Lensing I, Mller AL, Cosgarea R, Keilig L, Bourauel C, Jepsen S. Clin Oral Investig. Al-Zahrani MS. Implant therapy in aggressive periodontitis patients: a systematic review and clinical implications. [, Tobacco and its oxidation products are involved in the progression and clinical alterations of periodontal diseases. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. ; Mealey, B.L. Sreedevi, M.; Ramesh, A.; Dwarakanath, C. Periodontal status in smokers and nonsmokers: A clinical, microbiological, and histopathological study. PMC Conclusions: P: 904-398-1136 A systematic review and meta-analysis. The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. Chen JT, Wu IT, Huang RY, Lin YC, Chou YH, Lin T, Kuo PJ, Tu CC, Hou LT, Lai YL, Lu HK, Tsai CC, Yuan K, Chen CJ, Ho CS, Yang YC, Wu AY, Huang KC, Chiang CY, Chang PC. Therefore, following periodontitis treatment, besides its stage and grade classification, the patient must be classified into a stable or unstable periodontitis patient status. 2019. Rheumatoid arthritis: A 2020 systematic review indicates that periodontitis may increase the risk of developing rheumatoid arthritis. Methods: Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. A separate guideline covering the treatment of Stage IV periodontitis will be published. Epub 2021 Feb 8. The American Academy of Periodontology (AAP) announced new periodontal classifications for the AAP Guidelines. New classification of periodontal diseases (NCPD): an - Nature Unable to load your collection due to an error, Unable to load your delegates due to an error, Collaborators, Periodont. Bookshelf J Am Dent Assoc 2015;146(7):525-35. Careers. Today's Digital Media, LLC d/b/a Today's RDH, New AAP Periodontal Classification Guidelines, Periodontal Maintenance: Taking the Guesswork out of the 4910, Top 10 Essentials for Every Hygienists Toolkit, http://perio.org/sites/default/files/files/Staging%20and%20Grading%20Periodontitis.pdf, Periodontal Inflammation Linked to Vision Loss. Patients meeting the criteria of periodontitis stage III and IV, grade C are considered to be affected by severe and advanced forms of periodontitis with a rapid rate of progression. Associations, though not causal relationships, with periodontitis have been suggested for several conditions: Notably, the 2017 system published by AAP/EFP eliminates use of the diagnostic categories Chronic and Aggressive periodontitis. Periodontol 2000. J. Clin. If more than 30% of the teeth are involved, then periodontitis is considered generalized. 2018;45:149161. Based on the findings from step 1, a determination of mild-moderate periodontitis can be made, which is considered Stage I or Stage II. Periodontal Disease and Pregnancy Outcomes: Overview of Systematic Reviews. Lastly, certain risk factors are associated with progressive bone loss including smoking and diabetes. Periodontal disease and cancer: Epidemiologic studies and possible mechanisms. Females showed a significant increase in inflammatory infiltrate compared to males (6.29% vs. 2.28%. 25, Much of the literature agrees that, after non-surgical and/or surgical periodontal treatment, patients could benefit from more frequent visits, possibly every 3-6 months.26, 27 These appointments could include a review of home oral hygiene behaviors, ascertainment of exposure to risk factors such as tobacco use, professional plaque removal, and subgingival debridement, as needed.26-28 Patients also could be assessed to determine if active therapy is needed to treat recurrent periodontal disease.27, Researchers generally agree the maintenance phase is key to allow for close monitoring of the attachment level and pocket depth along with the other clinical variables, such as bleeding, exudation, tooth mobility.21. J Clin Periodontol. This is determined usually by comparing the patients disease level to their age. 0000018315 00000 n Dent Update. Extraction indicated if client and patient will not commit to daily home oral hygiene. sharing sensitive information, make sure youre on a federal The Veterinary Oral Health Council website (www.vohc.org ) provides further information about products that meet certain requirements for plaque and/or calculus control. 22. The American Academy of Periodontology defines non-surgical treatment as the professional removal of supragingival and subgingival bacterial plaque or biofilm and calculus, which provides a biologically acceptable root surface, as well as patient adoption of a comprehensive daily plaque or biofilm control routine. BMC Cardiovasc Disord 2017;17(1):50. A stage 3 furcation involvement exists when a periodontal probe extends under the crown of a multirooted tooth, through and through from one side of the furcation out the other. I 'hfW$gLSV(LgtB-erO8n=xO$0O~=~_|HHt>2q{|swiG "nx#+2>>?>|.> ?>|8~/|~!u`},,K@J-wT|}Y%|@iT, py.x\},\jVc+|o-1 5O SlH'0DSb4~]4w8N8#. JDR Clin Trans Res 2018;3(1):10-27. 0000090727 00000 n J. In particular, our null hypothesis had been to find a statistically significant major mean percentage of the vascular area and inflammatory cells in non-smoker patients due to the effects of smoking on biological tissues. 2017 Mar;21(2):485-503. Zeng XT, Leng WD, Lam YY, et al. This site needs JavaScript to work properly. A stage 1 mobility is present when tooth mobility is increased in any direction other than axial over a distance of >0.2 mm and up to 0.5 mm. A stage 1 furcation involvement exists when a periodontal probe extends less than halfway under the crown in any direction of a multirooted tooth with attachment loss. Evaluation of Microcirculation, Cytokine Profile, and Local Antioxidant Protection Indices in Periodontal Health, and Stage II, Stage III Periodontitis. 2017 Jun;44(6):612-9. Hu KF, Ho YP, Ho KY, Wu YM, Wang WC, Chou YH. A randomized controlled trial of implant-retained mandibular overdentures. Author to whom correspondence should be addressed. 8600 Rockville Pike This retrospective observational study was conducted at the Dental Clinic Lidia Verza, University of Brescia, Italy, from January 2014 to November 2016. A recent CDC report 1 provides the following data related to prevalence of periodontitis in the U.S.: 47.2% of adults aged 30 years and older have some form of periodontal disease. The connective tissue side of the flap needs to be debrided before wound closure to avoid contact of infected and inflamed granulation tissue with the planed root surfaces. Other antibiotics investigated for the treatment of Grade C periodontitis include amoxicillin-clavulanate potassium, tetracycline, ciprofloxacin, and . . Treatment of subjects with stage III-IV periodontitis and secondary malocclusions is complex, including a team approach (17, 22, 23). Patients often require several treatment sessions for complete debridement of the tooth surfaces.21 After scaling, root planing, and other adjunctive treatment approaches such as use of antibiotic therapy, the periodontal tissues require approximately 4 weeks to demonstrate optimal effects of nonsurgical therapy.21, Many moderate to advanced cases require surgical access to the root surface for root planing and reducing pocket depth, which will allow the patient to achieve successful home care.21, A patient with gingivitis can revert to a state of health with a reduced periodontium, but due to the host-related disease susceptibility, a periodontitis patient remains a periodontitis patient, even following successful therapy, and requires lifelong supportive care to prevent recurrence of disease.2 Further, patients with more severe periodontitis Stage and Grade have been found to be more likely to experience disease recurrence and tooth loss without regular periodontal maintenance visits. Periodontal disease and carotid atherosclerosis: A meta-analysis of 17,330 participants. Graetz C, Slzer S, Plaumann A, Schlattmann P, Kahl M, Springer C, et al. As the percentage of non-smokers who generally attend the clinic is about 60%, the sample size was calculated assuming a 2 vs. 3 ratio between arms (smokers vs. non-smokers). Depending on disease distribution and extent, periodontitis can be categorized into a localized (<30% of teeth involved) generalized or molar/incisor pattern [, The worst periodontal condition is evident in patients with generalized stage IIIIV, grade C periodontitis. Velidandla S, Bodduru R, Birra V, Jain Y, Valluri R, Ealla KKR. Response of chronic and aggressive periodontitis to treatment. This case highlights the need for consideration of multiple risk factors, especially when presenting in combination. Use to remove results with certain terms Liu Z, Gao X, Liang L, Zhou X, Han X, Yang T, Huang K, Lin Y, Deng S, Wang Z, Wang C. J Inflamm Res. [Introduction and interpretation of the European Federation of Periodontology S3 level clinical practice guideline for treatment of periodontitis]. https://www.mdpi.com/openaccess. MDPI and/or Lindhe, J.; Lang, N.P. Accessibility Gheisari R, Eatemadi H, Alavian A. Garbo D, Aimetti M, Bongiovanni L, Vidotto C, Mariani GM, Baima G, Romano F. Life (Basel). Xu S, Song M, Xiong Y, et al. There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. . Ad Hoc Committee on the Parameters of Care: Phase I therapy. 0000027037 00000 n J Clin Periodontol 2018;45 Suppl 20:S162-S70. 2000. Recommendations for treating stage I-III periodontitis in the Taiwanese population: A consensus report from the Taiwan Academy of Periodontology. All articles published by MDPI are made immediately available worldwide under an open access license. J Clin Periodontol. We do not control or have responsibility for the content of any third-party site. Evidence of the association of periodontitis with systemic conditions is mixed (see the related Oral Health Topic page, Oral/Systemic Health). Established periodontal disease with 25-50% attachment loss. 2023 Jan 17;16:235-244. doi: 10.2147/JIR.S395777. Journal of Periodontology, 89. doi:10.1002/jper.17-0739. ; Greenwell, H.; Kornman, K.S. Manifestations of systemic diseases and conditions that affect the periodontal attachment apparatus: Case definitions and diagnostic considerations. Get Directions These data are difficult to explain considering the multifactorial etiology of GPIIIIVC [. During the one and two-year follow-ups, the teeth and implants did not show any signs of instability, attachment loss or bone loss. Stage 4: There is advanced periodontitis, with >50% of attachment loss as measured by probing of the clinical attachment level or by radiographic determination of the distance of the alveolar margin from the cementoenamel junction relative to the length of the root, or there is a stage 3 furcation involvement in multirooted teeth (see below). You seem to have javascript disabled. 0000039969 00000 n Methods and Results A 62-year-old South Asian female presented with unstable Stage IV Grade C periodontitis, poor oral hygiene and multiple autoimmune conditions including oral lichen planus. Arn, M. L., Dritsas, K., Pandis, N., & Kloukos, D. (2020). Multiple external root resorptions in a patient with Stage IV, Grade C periodontitis and autoimmune diseases: A case report - Thandi - Clinical Advances in Periodontics - Wiley Online Library 2007 Dec;78(12):2229-37. Get Directions The inclusion criteria were age older than 18 years; no systemic illnesses or disorders; no medical treatment that may impair healing (immunodepression, immunosuppression, diabetes, etc. Periodontitis exists in different forms, and its etiology is related to multiple component causes. the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, Staging intends to classify the severity and extent of a patients disease based on a measurable amount of destroyed/damaged tissue from periodontitis. Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontitis, but includes the anatomical and functional sequelae of tooth and periodontal attachment loss (tooth flaring and drifting, bite collapse, etc. A., Melis, M., & Zawawi, K. H. (2021). BSP implementation of European S3 - level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice. Clinical effects of probiotic or azithromycin as an adjunct to scaling For more information on the new AAP periodontal classification guidelines, click here. Stage 1: There is gingivitis only, without attachment loss; the height and architecture of the alveolar margin are normal. Malinowski, B.; Wsierska, A.; Zalewska, K.; Sokoowska, M.M. A 2018 systematic review by Graziani et al. Kasprzak, A.; Surdacka, A.; Tomczak, M.; Konkol, M. Role of high endothelial postcapillary venules and selected adhesion molecules in periodontal diseases: A review. 0000110228 00000 n [. Our results showed that the vascular area was also more than halved in subjects with residual plaque on tooth surfaces. Accessibility Unauthorized use of these marks is strictly prohibited. 1899;41:248-64. 2015 May;113(5):371-82. A recent change to the classification of periodontal disease helps your periodontist express the severity and complexity of the disease (Staging) as well as the patients risk for progression (Grading). 14 on 251 periodontitis cases. 2023 Jan 13;12:1125463. doi: 10.3389/fcimb.2022.1125463. sharing sensitive information, make sure youre on a federal The goal of periodontal treatment is to eliminate plaque, biofilm and calculus, from the tooth surface and establish an environment that can be maintained in health.21 Treatment of periodontitis can be non-surgical or surgical. They can sometimes be saved through major periodontal surgery procedures, but disease will recur without drastic changes in home oral hygiene. generalized). ; Johnson, N.W. Oral Maxillofac. doi: 10.1111/jcpe.12945. The guidelines go on to endorse use of systemic sub-antimicrobial dose doxycycline along with scaling and root planing for patients with moderate-to-severe periodontitis. -, Cornelini R., Artese L., Rubini C., Fioroni M., Ferrero G., Santinelli A., Piattelli A. Vascular endothelial growth factor and microvessel density around healthy and failing dental implants. 0000099634 00000 n Bezrukova IV.The concept of maintenance therapy for periodontal inflammations characterized by an aggressive course .Stomatologiia (Mosk). Similarly, if periodontitis has progressed apically and reached the apex of the root of a tooth, secondary endodontic disease will develop. future research directions and describes possible research applications. All rights reserved. The authors declare no conflict of interest. A novel surgical approach for the management of soft tissues in regenerative procedures. A stage 0 mobility up to 0.2 mm is physiologic. 2014;65(1):107-33. J Clin Periodontol. The vascular density of the marginal gingiva is supported by arteries that extend into the periodontal ligament and the alveolar bone and periosteum [, The percentage of the vascular area was statistically significantly higher in the no plaque group than in the plaque group. Multiple requests from the same IP address are counted as one view. Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. 0000065735 00000 n ; E.B. In the literature, gender differences in periodontal diseases have been reported. Methods: The study included 27 adult patients (13 smoker, 14 non-smoker) with stage III/IV-grade C periodontitis and 25 healthy adult subjects. Stage III/grade C (55.77%) was the most common in the study by Graetz et al. Stage IV grade C periodontitis; Aggressive periodontitis; Dental implants; Maintenance; Regeneration. ; Schroeder, H.E. conceived and designed the experiments; B.B. Chronic kidney disease: Although there is no evidence on causal association, studies have shown a high periodontitis prevalence in chronic kidney disease populations also demonstrating racial and ethnic disparities. Angeline Kuznia and Douglas I. Storch, of Modern Periodontics PA. | All Rights Reserved 2018. Borsani, E.; Salgarello, S.; Mensi, M.; Boninsegna, R.; Stacchiotti, A.; Rezzani, R.; Sapelli, P.; Bianchi, R.; Rodella, L.F. Histochemical and immunohistochemical evaluation of gingival collagen and metalloproteinases in peri-implantitis. ; Bissada, N.F. o [alopecia OR hair loss ], , Dipl. Cao R, Li Q, Wu Q, et al. After the Stage is determined, the case is assigned one of three Grades (A, B, C) that indicate the potential for disease progression and treatment outcome (Table 1B). This case report shows that within the limitations of this study a successful outcome can be achieved with an early diagnosis and treatment involving elimination of infectious microorganisms and meticulous long-term maintenance combined with regenerative techniques and implant placement to restore the masticatory function and improve the quality of life for the patient. Keywords: A periodontal pocket is defined as a pathologically deepened gingiva sulcus, according to the definition reported by the American Academy of Periodontology. Pjetursson BE, Rast C, Brgger U, Schmidlin K, Zwahlen M, Lang NP. Use OR to account for alternate terms Continuous variables such as PPD and CAL loss were summarized as geometric mean and standard deviation (sd). 2020 Apr;91(4):442-453. doi: 10.1002/JPER.19-0141. Unauthorized use of these marks is strictly prohibited. Factors influencing the outcome of non-surgical periodontal treatment: A multilevel approach. 13th ed. MeSH National Library of Medicine It occurs with the destruction of the supporting periodontal tissue and migration of alveolar bone, periosteum, and periodontal ligament versus the tooth apex. Int J Periodontics Restorative Dent. The aim of this study was to understand if important factors such as smoking, gender, age, plaque, pus, and probing pocket depth could influence the histomorphological pattern of generalized stage III-IV, grade C periodontitis (GPIII-IVC), which is a particular form of periodontitis. Ramesh A, Ravi S, Kaarthikeyan G. Comprehensive rehabilitation using dental implants in generalized aggressive periodontitis. Periodontol 2000. Once the determination of periodontitis has been made, the disease is classified according to one of four Stages (I-IV) based upon the most severe area of disease presentation, which describe the disease severity and extent of disease, focusing on attachment and bone loss (Table 1A). Saving such teeth also requires endodontic therapy (see below), and the prognosis is determined by the extent of periodontal disease. While stages I to IV are defined based on the severity and complexity of management, grades A to C evidence the disease progression rate in three categories: slow, moderate, and rapid. Extensive disease seen in younger patients or with minimal bacterial deposits represents a high rate of progression (Grade C). Please let us know what you think of our products and services. "Periodontitis Stage IIIIV, Grade C and Correlated Factors: A Histomorphometric Study" Biomedicines 7, no. o [pig guinea] West N, Chapple I, Claydon N, D'Aiuto F, Donos N, Ide M, Needleman I, Kebschull M; British Society of Periodontology and Implant Dentistry Guideline Group Participants. ; G.G. Periodontal disease and tooth decay are the two biggest threats to dental health. Shallow periodontal pockets are treated in a closed fashion, but pockets >6 mm deep require open surgery (creation of a periodontal flap) to expose the root surface and alveolar bone for adequate treatment (root scaling/planing and alveoloplasty). Introduction 0000057263 00000 n J Public Health Dent 2013;73(2):112-9. Considering the vascular area, young patients showed a significant increase compared to older patients and it was higher in non-smokers than smokers. Biomedicines 2019, 7, 43. Women showed a statistically significantly higher percentage of inflammatory cells with respect to men and a non-significant reduction in the percentage of the vascular area.
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