Influência de polimorfismos genéticos do receptor TLR4 na evolução do dente avulsionado e reimplantado

Abstract

Introduction: Dental avulsion is one of the most severe and complex dental trauma injuries, often leading to inflammatory and resorptive sequelae even when clinical management follows established protocols. The variability in clinical outcomes suggests that genetic factors may influence the inflammatory response and prognosis of replanted teeth. The Toll-like receptor 4 (TLR4), a key component of innate immunity, plays a critical role in inflammatory and resorptive processes. Objective: To investigate the association between TLR4 gene polymorphisms and the clinical and radiographic outcomes of avulsed and replanted teeth after one year of follow-up. Methods: This study included 87 patients, 58 males and 29 females; aged 5–50 years, with avulsed and replanted teeth managed according to International Association of Dental Traumatology (IADT) guidelines. After one year, teeth were classified as having favorable or unfavorable outcomes based on clinical and radiographic criteria. Five TLR4 single nucleotide polymorphisms (rs2737190, rs2149356, rs1927914, rs1927911, and rs1927907) were genotyped by real-time PCR. Univariate and multivariate logistic regression analyses were performed, with a significance level set at p < 0.05. Results: Extra-alveolar time less than one hour (OR = 2.93; p = 0.016) and adequate storage medium (OR = 2.50; p = 0.046) were significantly associated with favorable outcomes. None of the analyzed TLR4 polymorphisms showed a statistically significant association with clinical or radiographic prognosis (p > 0.05). Conclusion: The evaluated TLR4 gene polymorphisms were not associated with clinical outcomes of avulsed and replanted teeth after one year of follow-up. Clinical factors, particularly extra-alveolar time and storage 11 medium, remain decisive prognostic determinants. The condition appears multifactorial, likely influenced by multiple genetic and environmental factors.