RESUMO
BACKGROUND AND OBJECTIVE: The central giant cell lesion (CGCL) is a benign intraosseous lesion that may resemble other giant cell-rich lesions, such as the peripheral giant cell lesion (PGCL). This lesion may be classified as aggressive or non-aggressive according to clinical and radiographic criteria, however, there is no biological marker that may help to define the CGCL based on the biological behavior. In this context, stromal cell phagocytosis has been described as an event related to aggressive lesions, however, only a few studies have investigated this phenomenon in CGCL. The aim of this study was to compare mononuclear cell phagocytosis by the multinucleated giant cells between aggressive, non-aggressive CGCL and PGCL. MATERIAL AND METHODS: Thirty-three cases of CGCL, 10 aggressive and 23 non-aggressive, and 20 cases of PGCL were included in this study. Phagocytosis events were evaluated in five consecutive microscopic fields from histological sections, stained with hematoxylin and eosin. The ratio between the numbers of phagocytosis/mm2and the total number of multinucleated giant cells/mm2was calculated. RESULTS: Phagocytosis was observed in the multinucleated giant cells of all cases. The density of phagocytosis/mm2in relation to giant cells/mm2was higher in the CGCL than in the PGCL. In addition, aggressive CGCL showed higher phagocytosis events when compared to the non-aggressive variant. CONCLUSION: Our results suggest that the aggressiveness of multinucleated giant cell lesions of the jaws may be related to the number of phagocytosis events in the lesion.
RESUMO
Introdução: Odontoma é o tumor odontogênico mais frequente e é diagnosticado durante as primeiras décadas de vida, devido ao atraso na erupção de um dente ou por meio de exame radiográfico de rotina. As características radiográficas e microscópicas são úteis para sua classificação em complexo ou composto. Odontomas em pacientes adultos são incomuns e podem ser complexos de tratar. Objetivo: O objetivo deste trabalho foi relatar a complexidade de tratamento de um odontoma composto em paciente adulto. Material e Método: o presente artigo é do tipo relato de caso. Resultados: Paciente do sexo feminino, 32 anos, compareceu ao cirurgião-dentista para avaliação clínica de rotina. Durante o exame clínico foi observada a ausência do dente 43, exames radiográficos demonstraram lesão mista, bem delimitada, com estruturas semelhantes a dentículos, localizada na região anterior de mandíbula do lado direito, entre as raízes dos dentes 42 e 44, promovendo deslocamento do dente 43 para a base da mandíbula. Devido à localização da lesão e seus efeitos no dente 43, a paciente foi submetida à ressecção da lesão sob anestesia geral. Foi realizada osteotomia na tábua óssea vestibular da mandíbula, remoção de múltiplas estruturas semelhantes a dentes, instalação de placa de reconstrução mandibular sistema 2.4 com cinco parafusos do mesmo sistema e enxerto ósseo com biomaterial aloplástico. O dente 13 foi extraído. As radiografias de controle pós-operatório evidenciaram bom posicionamento do material. O controle pós-operatório indica que a paciente encontra-se bem e sem ausência de sinais de recidiva ou complicações cirúrgicas. Conclusão: O diagnóstico tardio de odontomas associado ao deslocamento dentário ocasionado pelo tumor podem tornar o seu tratamento mais complexo.
Introduction: The most common odontogenic tumor is Odontoma, and is diagnosed during the first decades of life, due to a delayed eruption of a tooth, or through routine radiographic examination. From the radiographic and microscopic characteristics is classified into complex or compound. Odontomas in adult patients are uncommon and can have a complex treatment. Aim: The aim of this study was to report the complexity of treating a compound odontoma in an adult patient. Material and Methods: the present research is a case report. Results: A 32-year-old female patient attended the dental surgeon for routine evaluation. During the clinical examination, the absence of tooth 43 was observed, image exams revealed a well-defined mixed lesion consisting of denticles, located in the anterior region of the right mandible, between the roots of the teeth 42 and 44, the lesion promoted displacement of tooth 43. Due to the location and its effects on tooth 43, the patient underwent resection of the lesion under general anesthesia. Surgery proceeded with buccal plate osteotomy, removal of multiple tooth-like structures, installation of mandibular reconstruction plates 2.4 with five screws and bone graft with alloplastic biomaterial. Tooth 13 was extracted. Postoperative control radiographs showed good positioning of the material. Postoperative control show that patient does not have recurrence signal or complications due to surgery. Conclusion: Late diagnosis of odontomas associated with tooth displacement caused by the tumor may make its treatment more complex.