Brief communication
Clinicopathological and Immunohistochemical Study of Oral Amalgam Pigmentation
Estudio clínicopatológico e inmunohistoquímico de la pigmentación oral por amalgama
Beatriz Vera-Sireraa,
, Presentación Risueño-Matab, José M. Ricart-Vayác, Carmen Baquero Ruíz de la Hermosab, Francisco Vera-Sempered
Corresponding author
a Departamento de Estomatología, Universidad de Valencia, Valencia, Spain
b Servicio de Cirugía Maxilofacial, Hospital Universitario La Fe, Valencia, Spain
c Servicio de Dermatología, Hospital Universitario La Fe, Valencia, Spain
d Servicio de Anatomía Patológica, Departamento de Patología, Hospital Universitario La Fe, Universidad de Valencia, Valencia, Spain
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Ricart-Vayá, Carmen Baquero Ruíz de la Hermosa, Francisco Vera-Sempere" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Beatriz" "apellidos" => "Vera-Sirera" "email" => array:1 [ 0 => "vera_fra@gva.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Presentación" "apellidos" => "Risueño-Mata" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "José M." "apellidos" => "Ricart-Vayá" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Carmen" "apellidos" => "Baquero Ruíz de la Hermosa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Francisco" "apellidos" => "Vera-Sempere" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Departamento de Estomatología, Universidad de Valencia, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Maxilofacial, Hospital Universitario La Fe, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario La Fe, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Departamento de Patología, Hospital Universitario La Fe, Universidad de Valencia, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio clínicopatológico e inmunohistoquímico de la pigmentación oral por amalgama" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1354 "Ancho" => 1800 "Tamanyo" => 392413 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Discontinuous expression of metallothionein at the level of the basal layers of the mucosal epithelium, coinciding with granular deposits and in small, dense lumps of pigment material (metallothionein, 100×). (B) Expression of metallothionein at the level of the adventitial layer of small vessels (metallothionein, 400×). (C) Expression of HLA-DR marking intraepithelial dendritic cells, as well as subepithelial stromal elements and at the perivascular level (HLA-DR, 250×). (D) Immunoreactive stromal elements against CD117, identified as mast cells, at the level of the mucosal corium (CD117, 150×).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The term amalgam describes metal alloys used in tooth filling/restoration. Historically, this is the most widely used restorative element, due to its low cost and simple management.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Its use has declined since the 1990s, among other causes due to studies, sometimes contradictory, about the toxic effect of the mercurial component.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a> Its use has been banned in some countries, although the FDA only considers it as a Class II product (subject to special controls)<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and the American Dental Association (ADA) estimates that over 50.1%<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> of dental restorations taking place in the USA in 2009 employed silver amalgam.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Amalgam may produce local adverse effects,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,7</span></a> including mucosal pigmentation due to its metal components (silver, mercury, and tin). This is the most prevalent exogenous oral pigmentation<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> and can be confused with melanin pigmentation, in which case biopsy studies are indicated. In this sense, we studied the clinical, pathological, and immunohistochemical characteristics of a series of cases of oral pigmentation due to amalgam, all of which had undergone biopsy.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We analysed all oral biopsies performed at Hospital Universitario La Fe, in Valencia, Spain, during the period 2000–2010, through the software application PAT-Win<span class="elsevierStyleSup">®</span> v.3.4.1. We selected those which reported the existence of pigmentation due to amalgam, excluding those from periapical lesions. We obtained the clinical data of these biopsy cases through the MIZAR 2.0 application, noting age, gender, location, duration, reason for biopsy, and service which conducted it. In addition, we also obtained the imaging studies prior to biopsy, visualised with the IMPAX 6.4.0 platform.</p><p id="par0020" class="elsevierStylePara elsevierViewall">For each biopsy we carried out an observation with conventional and polarised light microscopy, as well as staining for iron pigment (Perls staining) and melanin (Masson-Fontana staining). In addition, we observed a histological section without any staining and subsequently conducted immunohistochemistry techniques for CD68, CD117, HLA-DR-α-chain, and metallothionein. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of the antibodies employed. All techniques were performed using the Dako<span class="elsevierStyleSup">®</span> Envision-Plus™ system, and we conducted thermal antigen retrieval with EnVision Flex Target Retrieval solution (Dako<span class="elsevierStyleSup">®</span>). We introduced positive and negative controls for evaluation in all the techniques.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">We collected 6 observations (5 females and 1 male, with a mean age of 56.5 years) of oral pigmentation due to amalgam. Their clinical and anamnestic data are listed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. All presented blackish blue oral regions, with a history of dental treatment. None of the imaging studies prior to biopsy showed radiopacity in the pigmented areas. In 4 patients, the biopsy was conducted in order to rule out melanin lesion; in 1 case the study was conducted due to marked cancerophobia and only in 1 case the resection was carried out for aesthetic reasons. Pigmentation areas were measured between 0.3 and 1<span class="elsevierStyleHsp" style=""></span>cm (with a mean diameter of 0.45<span class="elsevierStyleHsp" style=""></span>cm), and were present for a period between 2 months and 5 years, although 5 patients reported an enlargement in the 2–3 months prior to biopsy. The most common location was the gingival mucosa (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), followed by the jugal and palatal. All biopsies were obtained by oral surgeons, except for 1 case which was conducted by a dermatologist.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In all biopsies (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) some unstained sections contained the black colour of the pigment, with negative Perls and Masson-Fontana stains, thus excluding iron and melanin pigmentation. This pigmentation was observed as large deposits or in a fine granular form (0.1–0.5<span class="elsevierStyleHsp" style=""></span>μm) at the stromal, vascular, perineural, and muscular levels or in the submucosal salivary glands. The black, granular deposits located on elastic or collagen fibres were present in all observations, forming granular chains or in a disorderly manner. In 3 observations we also noted large and coarse deposits in the submucosal or muscular corium. Only the large deposits were surrounded by a fibrous capsule, usually free of inflammatory reaction. In order of frequency, fine stromal deposits were followed by adventitial vascular pigmentation (5 of 6 observations) and in 3 cases there was muscle fibre pigmentation in the perimysium and endomysium, often distant from other deposits, suggesting that this had contributed to increased pigmentation, as reported by 3 patients. Only in 1 case, with presence of large deposits, was there a foreign-body type granulomatous reaction, with giant cells which phagocytosed pigment. Polarised vision showed whitish or reddish, dual colouring refraction patterns. Large deposits showed no refractive character; this was only observable in the fine granular deposits, which were more evident with polarisation.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Immunohistochemically (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), we found CD68+ macrophage involvement in the case suffering a granulomatous, foreign-body type reaction. In the remaining cases, the presence of macrophages was low. However, the presence of CD117+ cells, identifiable as mast cells, was marked. Mast cells appeared at the subepithelial level and in the submucosa suffering pigmentation, as well as alongside large, coarse deposits. The expression of metallothionein was found in the mucosa, at the basal and suprabasal levels, coinciding with the presence of pigment in the corium. A weaker expression of metallothionein was observed perivascularly and in stromal elements. Moreover, an increase in the number of HLA-DR+ cells, often with dendritic morphology, was observed in the mucosal epithelium and in stromal elements of the corium, coinciding with areas of pigment deposit.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Oral pigmentation caused by amalgam is an adverse local effect<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,7</span></a> reported in patients undergoing dental treatment.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> It is caused by different mechanisms, including mechanical penetration into soft tissues, corrosion phenomena, and release of metallic components.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Pigmentation itself is harmless<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and relatively frequent,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> mainly affecting the mandibular gingival mucosa,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> followed by the buccal mucosa, floor of mouth, tongue, retromolar mandibular area, lips, and palate. It can also be observed in the maxilla and edentulous areas.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,12</span></a> It may be a cause for biopsy when mistaken with melanosis,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11–13</span></a> especially when there is no radiopacity. Metallic particles are radiopaque, thus facilitating the recognition of pigmentation.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> However, less than 25% of amalgam pigmentations are radiopaque<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,14</span></a> since their metallic particles are very small or are too dispersed to be visible in a radiographic study.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> In biopsy series, pigmentation is found in about 1.5% of all oral biopsies,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> thus giving an idea of the small number of cases in which they are biopsied. In population groups without biopsy studies, its presence is noted in 8.22% of the subjects, reaching 11.2% among women.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> As in our cases, this increased female incidence<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,15,16</span></a> is attributed to the fact that the female population has a greater tendency to seek dental care and, therefore, a greater likelihood of exposure to dental restorative materials.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Amalgam consists of 3 phases<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>: phase γ (SnAg<span class="elsevierStyleInf">3</span>), phase γ1 (Hg<span class="elsevierStyleInf">3</span>Ag<span class="elsevierStyleInf">2</span>), and phase γ2 (Sn<span class="elsevierStyleInf">8</span>Hg), with phase γ2 being the most corrodible.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> These phases have different degradation patterns,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> so they do not contribute equally to pigmentation. Phase γ2 is degraded rapidly and does not participate in pigmentation. Phase γ1 degrades slowly, with loss of Hg. Finally, phase γ degrades slowest and is responsible for the pigmentation, persisting as Ag and sulphur particles, associated with basal membranes or conjunctive tissue.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> There is no Hg in the pigment and Sn is lost by corrosion. Therefore, only Ag,<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18–20</span></a> in granular form, remains in the tissues and is responsible for pigmentation, as observed in our cases. As a cation, Ag becomes fixed to basal membranes, in collagen and elastic fibres and the perineuria,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> or may be phagocytosed by macrophages, being the only remaining component.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,18</span></a> Although all 3 phases are radiopaque, in the case of phase γ this radiopacity may disappear by fragmentation and dispersion after 1 year evolution.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> This explains the lack of radiopacity in many pigmentations<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,13,14</span></a> and their possible confusion with melanosis.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11–13</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In our cases, the fine granular deposits were the most frequent, as has also been reported by other authors.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Foreign-body type granulomas were observed in 1 case, with a similar incidence to that reported in the largest published series,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> specifically 13.4% granulomas. The presence of multinucleated cells was related to particle size, so only particles measuring 2.5–35<span class="elsevierStyleHsp" style=""></span>μm were phagocytosed by giant cells.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> This demonstrates<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,12,17,20</span></a> a relationship between tissue response and particle size. We only observed a fibrous capsule in large deposits and this was established at 4 weeks of metal implantation,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,17</span></a> in relation to corrosion of phase γ2. It is interesting to note that, in patients with increased pigmentation diameter, we observed an aspect reported by other authors,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> consisting in perimysium pigmentation distant from other deposits.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Immunohistochemically, we verified an elevated number of CD117+ mast cells. Only 1 previous study<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> noted this fact, indicating that this was independent of the size of pigment deposits.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> This finding is relevant, as certain heavy metals (Ag, Hg, Au) can influence the function and survival of mast cells,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and can cause autoimmune reactions in predisposed individuals, which would explain the appearance of lichenoid reactions.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Other data included the overexpression of metallothionein and HLA-DR. Metallothionein is a ubiquitous protein involved in the detoxification of metals and free radicals.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Our study, as well as others,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> found overexpression at the mucosal level, above the pigment deposits, and at the perivascular and stromal levels. However, we differ from those which only found immunoreactivity in macrophages near the deposits,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> correlating overexpression with residual Hg deposits. HLA-DR was overexpressed in intraepithelial dendritic cells, as well as at the perivascular level and in stromal elements. HLA-DR was expressed in antigen-presenting cells and its overexpression could be interpreted as a phenomenon induced by the metallic components in the context of pigment degradation processes.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres95043" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec82195" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres95042" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec82194" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of Interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec82195" "palabras" => array:4 [ 0 => "Amalgam" 1 => "Immunohistochemistry" 2 => "HLA-DR" 3 => "Metallothionein" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec82194" "palabras" => array:4 [ 0 => "Amalgama" 1 => "Inmunohistoquímica" 2 => "HLA-DR" 3 => "Metalotionina" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Amalgam tattoo, the most common exogenous oral pigmentation, can sometimes be confused with melanotic lesions, being then biopsied. We present the clinicopathological characteristics of 6 biopsied cases (5 females and 1 male) of oral amalgam pigmentation. The most common location was the gingival mucosa, followed by the buccal and palatal mucosa. Morphology and distribution (stromal, perivascular, perineural, and endomysial) of pigmentation were variable; there was only 1 case with fibrous capsular reaction and likewise only a single case of granulomatous foreign body reaction. Morphological variability is conditioned by the timing and amount of the pigment deposit, which is often associated with infiltration by mast cells (CD117+), as well as overexpression of metallothionein and HLA-DR at different tissue levels.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El tatuaje por amalgama, la pigmentación exógena oral más frecuente, puede en ocasiones simular lesiones melánicas y ser motivo de estudio biópsico. Se presentan las características clinicopatológicas de 6 pacientes (5 mujeres y un varón) biopsiados por pigmentación oral por amalgama. La localización más frecuente fue la mucosa gingival, seguida de la yugal y palatina. La morfología y distribución (estromal, perivascular, perineural y endomisial) de la pigmentación fue variable, apreciando solo en un caso reacción capsular fibrosa e igualmente, solo en un caso, reacción granulomatosa tipo cuerpo extraño. Esta variabilidad morfológica esta condicionada por la cuantía y cronología del depósito pigmentario, que a menudo esta asociado a una infiltración por mastocitos (CD117+), así como a una sobreexpresión de metalotionina y HLA-DR a diferentes niveles tisulares.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Vera-Sirera B, et al. Estudio clínicopatológico e inmunohistoquímico de la pigmentación oral por amalgama. Acta Otorrinolaringol Esp. 2012;63:376–81.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 554 "Ancho" => 1500 "Tamanyo" => 103085 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Image of pigmentation in the gingival mucosa (lower left canine), of 2 months evolution. (B) Pigmentation in edentulous gum, of 5 months of evolution, near to 2 molars with amalgam restoration.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1985 "Ancho" => 1800 "Tamanyo" => 591286 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A and B) Overview of oral biopsies showing pigment deposits in the corium (HE, 15×). (C) Fine granular deposits arranged in rows on the mucosal corium (HE, 400×). (D) Large, deep submucosal pigment deposit, surrounded by a dense fibrous capsule, also pigmented (HE, 200×). (E) Two granulomas with multinucleated giant cells in proximity to a muscular plane, with presence of large, black deposits (HE, 200×). (F) Striated muscle fibres with pigmented contours of fibrous sheaths (HE, 200×).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1354 "Ancho" => 1800 "Tamanyo" => 392413 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Discontinuous expression of metallothionein at the level of the basal layers of the mucosal epithelium, coinciding with granular deposits and in small, dense lumps of pigment material (metallothionein, 100×). (B) Expression of metallothionein at the level of the adventitial layer of small vessels (metallothionein, 400×). (C) Expression of HLA-DR marking intraepithelial dendritic cells, as well as subepithelial stromal elements and at the perivascular level (HLA-DR, 250×). (D) Immunoreactive stromal elements against CD117, identified as mast cells, at the level of the mucosal corium (CD117, 150×).</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Ab, antibody; Poly, polyclonal; RtU, ready to use.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Denomination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Type of antibody \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Clone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Source \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Dilution \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CD-68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mouse monoclonal Ab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">KP1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dakoppats<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RtU \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CD-117 (c-kit) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rabbit polyclonal Ab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ab Poly \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dakoppats<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/400 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HLA-DR α-chain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mouse monoclonal Ab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TAL.1B5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dakoppats<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Metallothionein \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mouse monoclonal Ab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">E-9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dakoppats<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/100 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab179919.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Antibodies Employed in the Study.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Observation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Location \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Size, cm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">History \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Biopsy/exeresis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Rx opacity \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alveolar mucosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Root canal 44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aesthetic reasons \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Palatine mucosa (1/3 post) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Root canal 26+restoration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Suspicion of melanoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Jugal mucosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.80×0.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Restoration 28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Suspicion of melanoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Jugal mucosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Apical surgery+exodontia 33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cancerophobia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gum mucosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Restoration and root canal 23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Suspicion of melanoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gum mucosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Root canal+apical surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Suspicion of melanotic lesion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab179920.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Clinical and Anamnestic Data.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The potential adverse health effects of dental amalgam" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.M. Brownawell" 1 => "S. Berent" 2 => "R.L. Brent" 3 => "J.V. Bruckner" 4 => "J. Doull" 5 => "E.M. Gershwin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Toxicol Rev" "fecha" => "2005" "volumen" => "24" "paginaInicial" => "1" "paginaFinal" => "10" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16042501" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trends in dental treatment, 1992 to 2007" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.A. Eklund" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Am Dent Assoc" "fecha" => "2010" "volumen" => "141" "paginaInicial" => "391" "paginaFinal" => "399" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20354088" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673698051459" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The amalgam controversy: where do we go from here" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.J. Christensen" 1 => "J.F. Simon" 2 => "H.E. Strassler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Compend Contin Educ Dent" "fecha" => "2011" "volumen" => "32" "paginaInicial" => "10" "paginaFinal" => "11" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22195341" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is it the end of the road for dental amalgam? A critical review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Shenoy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Conser Dent" "fecha" => "2008" "volumen" => "11" "paginaInicial" => "99" "paginaFinal" => "107" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is dental amalgam safe for humans? The opinion of the scientific committee of the European Commission" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Mutter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1745-6673-6-2" "Revista" => array:6 [ "tituloSerie" => "J Occup Med Toxicol" "fecha" => "2011" "volumen" => "6" "paginaInicial" => "2" "paginaFinal" => "19" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21232090" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dental devices: classification of dental amalgam, reclassification of dental mercury, designation of special controls for dental amalgam, mercury, and amalgam alloy. Final rule" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H.H.S. Food Drug Administration" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Fed Regist" "fecha" => "2009" "volumen" => "74" "paginaInicial" => "38685" "paginaFinal" => "38714" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19655469" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Local adverse effects of amalgam restorations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.J. McCullough" 1 => "M.J. Tyas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int Dent J" "fecha" => "2008" "volumen" => "58" "paginaInicial" => "3" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18350847" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Amalgam pigmentation (amalgam tattoo) of the oral mucosa. A clinicopathologic study of 268 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Buchner" 1 => "L.S. Hansen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Oral Surg Oral Med Oral Pathol" "fecha" => "1980" "volumen" => "49" "paginaInicial" => "139" "paginaFinal" => "147" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6928285" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Amalgam tattoo (amalgam pigmentation) of the oral mucosa: clinical manifestations, diagnosis and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Buchner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Refuat Hapeh Vehashinayim" "fecha" => "2004" "volumen" => "21" "paginaInicial" => "25" "paginaFinal" => "28" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15503979" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The mechanism of gingiva metallic pigmentations formations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Joska" 1 => "Z. Venclikova" 2 => "M. Poddana" 3 => "O. Benada" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Oral Invest" "fecha" => "2009" "volumen" => "13" "paginaInicial" => "1" "paginaFinal" => "7" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Immunolocalization of HLA-DR and metallothionein on amalgam tattoos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.M.A. Leite" 1 => "A.S. Botelho" 2 => "J.R. Oliveira" 3 => "S.V. Cardodo" 4 => "A.M. Loyola" 5 => "R.S. Gomez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "/S0103-64402004000200003" "Revista" => array:6 [ "tituloSerie" => "Braz Dent J" "fecha" => "2004" "volumen" => "15" "paginaInicial" => "99" "paginaFinal" => "103" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15776190" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mercury content in amalgam tattoos of human oral mucosa and its relation to local tissue reactions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Forsell" 1 => "B. Larson" 2 => "A. Ljungqvist" 3 => "B. Carlmark" 4 => "O. Johansson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Oral Sci" "fecha" => "1998" "volumen" => "106" "paginaInicial" => "582" "paginaFinal" => "587" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9527359" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Amalgam tattoo of the oral mucosa mimics malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Amano" 1 => "A. Tamura" 2 => "M. Yasuda" 3 => "M. Yamanaka" 4 => "Y. Takeuchi" 5 => "K. Sasaoka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1346-8138.2010.01007.x" "Revista" => array:6 [ "tituloSerie" => "J Dermatol" "fecha" => "2011" "volumen" => "38" "paginaInicial" => "101" "paginaFinal" => "103" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21175766" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disorders of pigmentation in the oral cavity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Eisen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Dermatol" "fecha" => "2000" "volumen" => "18" "paginaInicial" => "579" "paginaFinal" => "587" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11134853" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prevalence study of oral mucosal lesion in an adult Swedish population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T.A. Axell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Odont Rev" "fecha" => "1976" "volumen" => "27" "paginaInicial" => "68" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Foreign body gingival lesions: distribution, morphology, identification by X-ray energy dispersive analysis and possible origin of foreign material" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H.S. Koppang" 1 => "A. Roushan" 2 => "A. Srafilzadeh" 3 => "S.O. Stolen" 4 => "R. Koppang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Oral Pathol Med" "fecha" => "2007" "volumen" => "34" "paginaInicial" => "161" "paginaFinal" => "172" "itemHostRev" => array:3 [ "pii" => "S0140673602117673" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tissue reactions to implanted dental amalgam, including assessment by energy dispersive X-ray micro-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.M. Eley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/path.1711380307" "Revista" => array:6 [ "tituloSerie" => "J Pathol" "fecha" => "1982" "volumen" => "138" "paginaInicial" => "251" "paginaFinal" => "272" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6752362" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reconstructive mucogingival surgery: the management of amalgam tattoo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Shiloah" 1 => "J.S. Covington" 2 => "N.J. Schuman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Quintessence Int" "fecha" => "1988" "volumen" => "19" "paginaInicial" => "489" "paginaFinal" => "492" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3269597" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tissue reactions to the separate implantation of individual constituent of dental amalgam, including assessment by energy dispersive X-ray microanalysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.M. Eley" 1 => "J.R. Garrett" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Biomaterials" "fecha" => "1983" "volumen" => "4" "paginaInicial" => "73" "paginaFinal" => "80" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6860760" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Amalgam tattoos: light an electron microscopy and electro-probe micro-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.D. Harrison" 1 => "P.S.A. Rowley" 2 => "P.D. Peters" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/path.1711210204" "Revista" => array:6 [ "tituloSerie" => "J Pathol" "fecha" => "1977" "volumen" => "121" "paginaInicial" => "83" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/327039" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autoinmunity-inducing metals (Hg, Au and Ag) modulate mast cell signaling, function and survival" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y. Suzuki" 1 => "T. Inoue" 2 => "C. Ra" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Pharm Des" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "3805" "paginaFinal" => "3814" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22103852" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metallothionein: the multipurpose protein" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Coyle" 1 => "J.C. Philcox" 2 => "L.C. Carey" 3 => "A.M. Rofe" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cell Mol Life Sci" "fecha" => "2002" "volumen" => "59" "paginaInicial" => "627" "paginaFinal" => "647" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12022471" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metallothionein in human gingival amalgam tattoos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.C. Lau" 1 => "L. Jackson-Boeters" 2 => "T.D. Daley" 3 => "G.P. Wysocki" 4 => "M.G. Cherian" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Oral Biol" "fecha" => "2001" "volumen" => "46" "paginaInicial" => "1015" "paginaFinal" => "1020" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11543708" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735735/0000006300000005/v1_201304231523/S2173573512000944/v1_201304231523/en/main.assets" "Apartado" => array:4 [ "identificador" => "5882" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Brief Communication" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735735/0000006300000005/v1_201304231523/S2173573512000944/v1_201304231523/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573512000944?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 4 | 1 | 5 |
| 2021 March | 0 | 11 | 11 |
| 2021 February | 0 | 13 | 13 |
| 2021 January | 0 | 1 | 1 |
| 2020 December | 0 | 4 | 4 |
| 2020 October | 0 | 1 | 1 |
| 2020 August | 0 | 2 | 2 |
| 2020 May | 0 | 1 | 1 |
| 2020 April | 0 | 4 | 4 |
| 2020 March | 17 | 9 | 26 |
| 2020 February | 24 | 7 | 31 |
| 2020 January | 24 | 10 | 34 |
| 2019 December | 35 | 12 | 47 |
| 2019 November | 24 | 7 | 31 |
| 2019 October | 118 | 6 | 124 |
| 2019 September | 18 | 7 | 25 |
| 2019 August | 19 | 2 | 21 |
| 2019 July | 12 | 21 | 33 |
| 2019 June | 48 | 37 | 85 |
| 2019 May | 138 | 41 | 179 |
| 2019 April | 76 | 14 | 90 |
| 2019 March | 21 | 8 | 29 |
| 2019 February | 14 | 7 | 21 |
| 2019 January | 14 | 10 | 24 |
| 2018 December | 23 | 13 | 36 |
| 2018 November | 22 | 5 | 27 |
| 2018 October | 38 | 11 | 49 |
| 2018 May | 3 | 0 | 3 |
| 2018 April | 23 | 0 | 23 |
| 2018 March | 20 | 5 | 25 |
| 2018 February | 23 | 2 | 25 |
| 2018 January | 17 | 5 | 22 |
| 2017 December | 15 | 3 | 18 |
| 2017 November | 17 | 4 | 21 |
| 2017 October | 23 | 12 | 35 |
| 2017 September | 24 | 13 | 37 |
| 2017 August | 26 | 9 | 35 |
| 2017 July | 25 | 6 | 31 |
| 2017 June | 32 | 15 | 47 |
| 2017 May | 38 | 17 | 55 |
| 2017 April | 31 | 23 | 54 |
| 2017 March | 35 | 22 | 57 |
| 2017 February | 43 | 12 | 55 |
| 2017 January | 27 | 5 | 32 |
| 2016 December | 55 | 13 | 68 |
| 2016 November | 40 | 18 | 58 |
| 2016 October | 39 | 24 | 63 |
| 2016 September | 49 | 11 | 60 |
| 2016 August | 34 | 6 | 40 |
| 2016 July | 17 | 2 | 19 |
| 2016 June | 33 | 13 | 46 |
| 2016 May | 29 | 27 | 56 |
| 2016 April | 40 | 19 | 59 |
| 2016 March | 32 | 20 | 52 |
| 2016 February | 46 | 32 | 78 |
| 2016 January | 53 | 20 | 73 |
| 2015 December | 36 | 13 | 49 |
| 2015 November | 34 | 21 | 55 |
| 2015 October | 49 | 32 | 81 |
| 2015 September | 31 | 14 | 45 |
| 2015 August | 52 | 13 | 65 |
| 2015 July | 63 | 11 | 74 |
| 2015 June | 25 | 9 | 34 |
| 2015 May | 36 | 13 | 49 |
| 2015 April | 55 | 11 | 66 |
| 2015 March | 43 | 15 | 58 |
| 2015 February | 32 | 9 | 41 |
| 2015 January | 37 | 12 | 49 |
| 2014 December | 46 | 8 | 54 |
| 2014 November | 24 | 9 | 33 |
| 2014 October | 48 | 14 | 62 |
| 2014 September | 47 | 8 | 55 |
| 2014 August | 24 | 10 | 34 |
| 2014 July | 25 | 7 | 32 |
| 2014 June | 9 | 11 | 20 |
| 2014 May | 11 | 4 | 15 |
| 2014 April | 11 | 7 | 18 |
| 2014 March | 18 | 7 | 25 |
| 2014 February | 14 | 7 | 21 |
| 2014 January | 18 | 6 | 24 |
| 2013 December | 12 | 4 | 16 |
| 2013 November | 10 | 10 | 20 |
| 2013 October | 45 | 14 | 59 |
| 2013 September | 32 | 2 | 34 |
| 2013 August | 12 | 1 | 13 |
| 2013 July | 1 | 0 | 1 |
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