Effectiveness of low power laser in reducing postoperative signs and symptoms after third molar surgery: a triple-blind clinical trial.

The objective of this research was to evaluate the effectiveness of using LPL (Low power laser) to reduce pain, edema, and trismus after impacted lower third molar extraction. A split-mouth randomized triple-blind clinical trial was conducted at the Federal University of Ceará. For inclusion criteria, it was necessary that the patient presented a clear indication for removal of both lower third molars, in addition to both molars being in similar positions. The third molars (38 and 48) were randomly allocated to the test group that received the LPL application protocol, and to the placebo group that received a simulation of the protocol, making a total sample of 44 surgeries. Patients in the test group used an average of 50% of the amount of analgesics that was used by the placebo group, however, there was a statistically significant difference only on days four and five. Regarding trismus, the test group presented wide mouth openings, both at 48 hours and at 7 days after surgery compared to the placebo group, but without a statistically significant difference. For edema, we noted an equilibrium between the test group and the placebo group, but no measurement obtained a statistically significant difference. The use of LPL presented better pain and trismus indicators after complex extractions. The use of LPL is thus indicated as a complementary therapy to reduce postoperative discomfort caused by complex tooth extractions.

Oral cancer mortality and factors associated in the state of Ceara, Brazil, 2009-2019: a spatial analysis. / Mortalidade por câncer de boca e fatores associados no Ceará, Brasil, 2009-2019: uma análise espacial.

The study aimed to analyze the spatial distribution and factors associated with oral cancer mortality in the 2009-2019 period in the municipalities of Ceará, Brazil. This ecological study of oral cancer deaths used distribution analysis, autocorrelation, and spatial regression. The oral cancer mortality rate has spatial autocorrelation. In the geographically weighted regression analysis, a negative relationship was observed between mortality and the number of households with access to the sewage system (ß = -0.001) and the mean number of people per household (ß = -5.947). We observed a positive relationship between mortality and percentage of oral health coverage in Primary Health Care (ß = 0.021), number of people living in the rural area of ​​the municipality (ß = 0.0001), Municipal Human Development Index (ß = 40.417), and aging rate (ß = 1.169). We can conclude that the influence on the mortality risk showed spatial clusters that require priority in public policies that impact oral cancer morbimortality.

O estudo objetivou analisar a distribuição espacial e fatores associados à mortalidade por câncer de boca no período de 2009-2019 nos municípios do Ceará, no Brasil. Trata-se de um estudo ecológico dos óbitos por câncer de boca utilizando análise de distribuição, autocorrelação e regressão espacial. O coeficiente de mortalidade por câncer de boca possui autocorrelação espacial. Na análise de regressão geograficamente ponderada, observou-se relação negativa entre mortalidade e número de moradias com acesso à rede de esgoto (ß = -0,001) e média de pessoas por domicílio (ß = -5,947). Observou-se relação positiva entre mortalidade e percentual de cobertura de saúde bucal na Atenção Primária à Saúde (ß = 0,021), número de pessoas que vivem na zona rural do município (ß = 0,0001), Índice de Desenvolvimento Humano Municipal (ß = 40,417) e taxa de envelhecimento (ß = 1,169). Pode-se concluir que a influência sobre o risco de mortalidade evidenciou aglomerados espaciais que requerem prioridade em políticas públicas que impactem na morbimortalidade por câncer de boca.

Angioleiomioma oral mimetizando um granuloma piogênico: relato de caso raro / Oral Angioleiomyoma mimetizing a pyogenic granuloma: A rare case report

Angioleiomioma (AL) é um tumor benigno de origem perivascular que raramente é observado na cavidade oral, principalmente em localizações como a gengiva. Devido sua apresentação clínica inespecífica, os ALs podem mimetizar outras lesões orais, como tumores benignos de glândulas salivares e lesões reacionais, como o granuloma piogênico. O presente artigo objetiva relatar um caso raro de AL localizado em gengiva, em uma paciente de 19 anos. Clinicamente, a lesão apresentava-se como um tumor assintomático, oval, pedunculado, bem definido, com superfície lisa, consistência fibrosa e cor eritematosa, semelhante a um granuloma piogênico, Uma biópsia excisional foi realizada e o fragmento foi encaminhado para análise histopatológica, que revelou uma proliferação vascular de diversos calibres, contendo paredes musculares espessas e proliferação muscular adjacente, além de infiltrado inflamatório, predominantemente crônico, hemácias extravasadas e área de ulceração, consistente com o diagnóstico de AL inflamado. A histopatologia desempenha um papel importante no diagnóstico final de lesões raras e com características clínicas inespecíficas. A excisão cirúrgica da lesão é o tratamento de escolha mais eficaz para os ALs orais. (AU)

Angioleiomyoma (AL) is a benign tumor of smooth muscle of perivascular origin that is rarely seen in the oral cavity, mainly in locations like the gingiva. Due to their nonspecific clinical presentation, ALs can mimic other oral lesions, such as benign salivary gland tumors and reactional lesions, as a pyogenic granuloma. We reported a case of an AL located in the gingiva in a 19-year-old female patient. In clinical terms, the lesion was presented as an asymptomatic, oval, pedunculated, well-defined nodule with a smooth surface, fibrous consistency and erythematous color, similar to a pyogenic granuloma. An excisional biopsy was performed and the fragment was sent for histopathological analysis that revealed a vascular proliferation of different calibers, containing thick muscle walls and adjacent muscle proliferation, in addition to an inflammatory infiltrate, predominantly chronic, extravasated red blood cells and an area of ulceration, consistent with the diagnosis of inflamed AL. The histopathology plays an important role in the final diagnosis of rare lesions and with nonspecific clinical characteristics. The surgical excision of the lesion is the most effective treatment of choice for oral ALs. (AU)

Effectiveness of low power laser in reducing postoperative signs and symptoms after third molar surgery: a triple-blind clinical trial

Abstract The objective of this research was to evaluate the effectiveness of using LPL (Low power laser) to reduce pain, edema, and trismus after impacted lower third molar extraction. A split-mouth randomized triple-blind clinical trial was conducted at the Federal University of Ceará. For inclusion criteria, it was necessary that the patient presented a clear indication for removal of both lower third molars, in addition to both molars being in similar positions. The third molars (38 and 48) were randomly allocated to the test group that received the LPL application protocol, and to the placebo group that received a simulation of the protocol, making a total sample of 44 surgeries. Patients in the test group used an average of 50% of the amount of analgesics that was used by the placebo group, however, there was a statistically significant difference only on days four and five. Regarding trismus, the test group presented wide mouth openings, both at 48 hours and at 7 days after surgery compared to the placebo group, but without a statistically significant difference. For edema, we noted an equilibrium between the test group and the placebo group, but no measurement obtained a statistically significant difference. The use of LPL presented better pain and trismus indicators after complex extractions. The use of LPL is thus indicated as a complementary therapy to reduce postoperative discomfort caused by complex tooth extractions.

Resumo O objetivo desta pesquisa é avaliar a eficácia do uso de LBP (laser de baixa potência) na redução da dor, edema e trismo após exodontia de terceiros molares inferiores impactados. Ensaio clínico randomizado triplo-cego do tipo boca dividida foi realizado na Universidade Federal do Ceará. Para os critérios de inclusão era necessário que o paciente apresentasse indicação clara para a remoção de ambos os terceiros molares inferiores, além da obrigatoriedade de que ambos os molares estivessem em posições semelhantes segundo Winter (1926) e Pell & Gregory (1933). Os terceiros molares (38 e 48) foram alocados aleatoriamente no grupo teste que recebeu o protocolo de aplicação dO LBP e no grupo placebo que recebeu a simulação do protocolo, perfazendo uma amostra total de 44 cirurgias. Os pacientes do grupo teste usaram em média 1/2 da quantidade de analgésicos do que os do grupo placebo, porém, apenas nos dias quatro e cinco houve diferença estatisticamente significativa. Em relação ao trismo, o grupo teste apresentou melhores indicadores tanto em 48 horas quanto em 7 dias após a cirurgia em relação ao grupo placebo, mas sem diferença estatisticamente significante. Em relação ao edema, houve medidas na amostra favoráveis ​​ao grupo teste e medidas favoráveis ao grupo placebo, mas nenhuma das medidas obteve diferença estatisticamente significativa. O uso de LBP mostrou melhores indicadores de dor e trismo após extrações complexas. Portanto, o uso de LBP é indicado como terapia complementar para reduzir morbidades causadas por exodontias complexas.

Associação entre lesões de hpv e os carcinomas genitais e da cavidade oral: uma revisão narrativa / Association between hpv lesions and genital and oral cavity carcinomas: a narrative review / Asociación entre lesiones por vph y carcinomas genitales y de cavidad oral: una revisión narrativa

Os Papilomavírus Humano (HPVs) são membros da família Papilomaviridae. O vírus destaca-se pelo seu tropismo por células epiteliais, infectando exclusivamente mucosa epitelial e cutânea. O HPV-16 e HPV-18 são subtipos classificados como de alto risco, conhecidos por sua oncogenicidade, fortemente associados aos cânceres anais, genitais e de orofaringe. Lesões por HPV representam um grande grupo de doenças sexualmente transmissíveis. O objetivo do presente estudo consistiu em realizar uma revisão narrativa sobre a associação entre lesões por HPV e carcinomas genitais e da cavidade oral. Realizamos uma busca na base de dados eletrônicos PubMed, Lilacs, Scielo, Medline e Google Scholar, sendo utilizados artigos publicados entre os anos de 2017-2021, ao fim, foram selecionados 36 artigos. Grande parte das infecções por HPV são subclínicas, ou seja, não apresentam sintomatologia importante e tendem a desaparecer espontaneamente. Desta forma, faz-se necessário ter conhecimento a respeito dos aspectos clínicos e comportamentais dessas lesões, possibilitando o diagnóstico precoce, evitando a evolução para estágios mais invasivos, favorecendo um tratamento efetivo e melhor prognóstico.

Human Papillomaviruses (HPVs) are members of the Papilomaviridae family. The virus stands out for its tropism for epithelial cells, exclusively infecting epithelial and cutaneous mucosa. O HPV-16 and HPV-18 are subtypes classified as high risk, known for their oncogenicity, strongly associated with anal, genital and oropharyngeal cancers. HPV lesions represent a large group of sexually transmitted diseases. The objective of this study was to carry out a narrative review on the association between HPV lesions and genital and oral cavity carcinomas. We carried out a search in the electronic databases PubMed, Lilacs, Scielo, Medline and Google Scholar, using articles published between the years of 2017-2021, at the end, foram selected 36 articles. A large part of HPV infections are subclinical, or seem to, do not present significant symptoms and tend to disappear spontaneously. In this way, it is necessary to be aware of the two clinical and behavioral aspects of these injuries, enabling early diagnosis, avoiding evolution to more invasive stages, favoring effective treatment and better prognosis.

Los virus del papiloma humano (VPH) son miembros de la familia Papillomaviridae. El virus destaca por su tropismo por las células epiteliales, infectando exclusivamente mucosas epiteliales y cutáneas. El VPH-16 y el VPH-18 son subtipos clasificados como de alto riesgo, conocidos por su oncogenicidad, fuertemente asociados con cánceres anales, genitales y orofaríngeos. Las lesiones por VPH representan un gran grupo de enfermedades de transmisión sexual. El objetivo del presente estudio fue realizar una revisión narrativa sobre la asociación entre las lesiones por VPH y los carcinomas genitales y de cavidad oral. Realizamos una búsqueda en la base de datos electrónica PubMed, Lilacs, Scielo, Medline y Google Scholar, utilizando artículos publicados entre los años 2017-2021, al final se seleccionaron 36 artículos. La mayoría de las infecciones por VPH son subclínicas, es decir, no presentan síntomas importantes y tienden a desaparecer espontáneamente. Por lo tanto, es necesario tener conocimiento sobre los aspectos clínicos y conductuales de estas lesiones, que permitan un diagnóstico precoz, evitando la progresión a estadios más invasivos, favoreciendo un tratamiento eficaz y un mejor pronóstico.

Mortalidade por câncer de boca e fatores associados no Ceará, Brasil, 2009-2019: uma análise espacial / Oral cancer mortality and factors associated in the state of Ceara, Brazil, 2009-2019: a spatial analysis

Resumo O estudo objetivou analisar a distribuição espacial e fatores associados à mortalidade por câncer de boca no período de 2009-2019 nos municípios do Ceará, no Brasil. Trata-se de um estudo ecológico dos óbitos por câncer de boca utilizando análise de distribuição, autocorrelação e regressão espacial. O coeficiente de mortalidade por câncer de boca possui autocorrelação espacial. Na análise de regressão geograficamente ponderada, observou-se relação negativa entre mortalidade e número de moradias com acesso à rede de esgoto (β = -0,001) e média de pessoas por domicílio (β = -5,947). Observou-se relação positiva entre mortalidade e percentual de cobertura de saúde bucal na Atenção Primária à Saúde (β = 0,021), número de pessoas que vivem na zona rural do município (β = 0,0001), Índice de Desenvolvimento Humano Municipal (β = 40,417) e taxa de envelhecimento (β = 1,169). Pode-se concluir que a influência sobre o risco de mortalidade evidenciou aglomerados espaciais que requerem prioridade em políticas públicas que impactem na morbimortalidade por câncer de boca.

Abstract The study aimed to analyze the spatial distribution and factors associated with oral cancer mortality in the 2009-2019 period in the municipalities of Ceará, Brazil. This ecological study of oral cancer deaths used distribution analysis, autocorrelation, and spatial regression. The oral cancer mortality rate has spatial autocorrelation. In the geographically weighted regression analysis, a negative relationship was observed between mortality and the number of households with access to the sewage system (β = -0.001) and the mean number of people per household (β = -5.947). We observed a positive relationship between mortality and percentage of oral health coverage in Primary Health Care (β = 0.021), number of people living in the rural area of ​​the municipality (β = 0.0001), Municipal Human Development Index (β = 40.417), and aging rate (β = 1.169). We can conclude that the influence on the mortality risk showed spatial clusters that require priority in public policies that impact oral cancer morbimortality.

Displasia dentinária tipo i: relato de caso / Dentin dysplasia type i: case report / Displasia dentinaria tipo i: informe de un caso

A displasia dentinária tipo I é um distúrbio hereditário autossômico dominante raro, associada a uma malformação da dentina radicular, que pode causar a perda espontânea dos dentes. Clinicamente, os dentes apresentam aspectos de normalidade, no entanto, radiograficamente, podem ser observadas raízes curtas e mal formadas. O objetivo desse trabalho foi relatar o diagnóstico de uma paciente portadora de displasia dentinária tipo I. Paciente, M.G.S, sexo feminino, 34 anos, compareceu a Clínica Odontológica da UFC ­ Sobral com intuito de fazer uma nova prótese parcial removível. Ao realizar o exame clínico, contatou-se que a paciente apresentava uma boa higiene oral, porém observou-se mobilidade e dor nos dentes 12, 13, 23, 32 e 33, além do relato de perda precoce de outros elementos dentários devido a mobilidade. Foram realizadas radiografias periapicais, onde foi observado pela primeira vez o aspecto encurtado de todas as raízes dentárias. O encurtamento das raízes foi novamente observado na radiografia panorâmica e na tomografia computadorizada solicitadas a paciente. Após o estudo do caso, a paciente foi diagnosticada com Displasia Dentinária tipo I. A paciente foi reabilitada com prótese protocolo superior e inferior. Conclui-se que a Displasia Dentinária tipo I é uma condição rara e que afeta a dentina radicular de dentes decíduos e permanentes. O tratamento da DDI é difícil e requer abordagem multidisciplinar, devendo devolver a autoestima, além de favorecer a função mastigatória e a estética.

Dentin dysplasia dentin type I is a rare autosomal dominant hereditary disorder associated with a root dentin malformation that can cause spontaneous tooth loss. Clinically, the teeth present normal aspects; however, radiographically, short and malformed roots can be observed. The aim of this paper was to report the diagnosis of a patient with dentin dysplasia type I. Patient, M.G.S, female, 34 years, attended the Dental Clinic of UFC - Sobral in order to make a new partial denture. During clinical examination it was found that the patient had good oral hygiene, but there was mobility and pain in teeth 12, 13, 23, 32 and 33, besides the report of early loss of other teeth due to mobility. Periapical radiographs were taken, where the shortened appearance of all dental roots was first observed. The shortening of the roots was again observed in the panoramic radiograph and CT scan requested from the patient. After the case study, the patient was diagnosed with Dentin Dysplasia type I. The patient was rehabilitated with upper and lower protocol prosthesis. It is concluded that Dentin Dysplasia type I is a rare condition and affects the root dentin of deciduous and permanent teeth. The treatment of DDI is difficult and requires a multidisciplinary approach, and should restore self-esteem, in addition to favoring masticatory function and aesthetics.

La displasia dentinaria tipo I es un trastorno hereditario autosómico dominante poco frecuente asociado a una malformación de la dentina radicular que puede causar la pérdida espontánea de dientes. Clínicamente, los dientes presentan aspectos normales; sin embargo, radiográficamente pueden observarse raíces cortas y malformadas. El objetivo de este estudio fue informar sobre el diagnóstico de un paciente con displasia dentinaria tipo I. Paciente, M.G.S, sexo femenino, 34 años, acudió a la Clínica Odontológica de UFC - Sobral con el objetivo de realizar una nueva prótesis parcial removible. En el examen clínico, se constató que la paciente tenía buena higiene bucal, pero se observó movilidad y dolor en los dientes 12, 13, 23, 32 y 33, y el informe de pérdida precoz de otros elementos dentales debido a la movilidad. Se tomaron radiografías periapicales y por primera vez se observó el aspecto acortado de todas las raíces dentales. El acortamiento de las raíces se observó de nuevo en la radiografía panorámica y el TAC solicitados a la paciente. Tras el estudio del caso, la paciente fue diagnosticada de displasia dentinaria tipo I. La paciente fue rehabilitada con prótesis de protocolo superior e inferior. Se concluye que la Displasia Dentinaria tipo I es una enfermedad rara y afecta a la dentina radicular de los dientes deciduos y permanentes. El tratamiento de la DDI es difícil y requiere un abordaje multidisciplinar, debiendo restaurar la autoestima, además de favorecer la función masticatoria y la estética.

Extenso lipoma em localização incomum e com 10 anos de evolução: relato de caso / Extensive lipoma in unusual location and with 10 years of evolution: case report / Lipoma extenso en localización inusual y con 10 años de evolución: informe de un caso

O lipoma é um tumor benigno de gordura que representa a neoplasia mesenquimal mais comum e pode acometer a região de cabeça e pescoço. São mais frequentes em indivíduos obesos, entretanto, o metabolismo dos lipomas é independente da gordura corpórea normal. Caracterizam-se como aumentos de volume nodulares de superfície lisa e consistência macia que podem ser sesséis ou pedunculados, são normalmente assintomáticos e os sítios de acometimento menos comuns incluem a língua, o assoalho da boca e os lábios. Dessa forma, o presente artigo tem como objetivo relatar um caso clínico de lipoma com anos de evolução e localizado em uma região incomum. A paciente do sexo feminino foi encaminhada para a Clínica de Estomatologia da Faculdade de Odontologia do Campus UFC-Sobral relatando que apresentava a lesão desde o ano de 2010 e afirmando que nunca realizou tratamento prévio e que não havia fator causal conhecido. Ao exame clínico observou-se uma lesão nodular de cor amarelada, medindo cerca de 1,5cm localizada na região de borda lateral, ventre e dorso de língua do lado direito compatível com a hipótese diagnóstica de lipoma. Nesse sentido, a partir da anamnese e dos achados clínicos optou-se por realizar a biópsia excisional para confirmação do diagnóstico. Com os resultados da biópsia houve a comprovação da hipótese diagnóstica, e sendo assim, não houve necessidade de tratamentos adicionais. Portanto, a partir desse caso pode-se perceber que o lipoma pode ser uma lesão que pode perdurar por vários anos sem maiores complicações, entretanto pode atingir grandes dimensões e nesses casos o tratamento cirúrgico se faz necessário.

Lipoma is a benign fat tumor that represents the most common mesenchymal neoplasm and can affect the head and neck region. They are more frequent in obese individuals, however, the metabolism of lipomas is independent of normal body fat. They are characterized as smooth-surfaced nodular masses that can be sessile or pedunculated, are usually asymptomatic, and the less common sites of involvement include the tongue, the floor of the mouth, and the lips. Thus, the present article aims to report a clinical case of a lipoma with years of evolution and located in an uncommon region. The female patient was referred to the Stomatology Clinic of the School of Dentistry, UFC-Sobral Campus reporting that she presented the lesion since the year 2010 and stating that she had never undergone previous treatment and that there was no known causal factor. On clinical examination we observed a yellowish nodular lesion measuring about 1.5cm located in the region of the lateral border, belly and dorsum of the tongue on the right side compatible with the diagnostic hypothesis of lipoma. Therefore, based on the anamnesis and clinical findings, it was decided to perform an excisional biopsy to confirm the diagnosis. With the results of the biopsy, the diagnostic hypothesis was confirmed, and thus there was no need for additional treatments. Therefore, from this case we can see that lipoma can be a lesion that can last for several years without major complications, however, it can reach large dimensions and in these cases surgical treatment is necessary.

El lipoma es un tumor graso benigno que representa la neoplasia mesenquimatosa más frecuente y puede afectar a la región de cabeza y cuello. Son más frecuentes en individuos obesos, sin embargo, el metabolismo de los lipomas es independiente de la grasa corporal normal. Se caracterizan por ser masas nodulares de superficie lisa que pueden ser sésiles o pediculadas, suelen ser asintomáticas y los lugares menos frecuentes de afectación incluyen la lengua, el suelo de la boca y los labios. Así, el presente artículo pretende informar de un caso clínico de lipoma de años de evolución y localizado en una región poco frecuente. La paciente fue referida a la Clínica de Estomatología de la Facultad de Odontología, Campus UFC-Sobral informando que presentaba la lesión desde 2010 y afirmando que nunca había sido sometida a tratamiento previo y que no existía factor causal conocido. El examen clínico reveló una lesión nodular de color amarillento, de aproximadamente 1,5 cm localizada en la región del borde lateral, vientre y dorso de la lengua del lado derecho compatible con la hipótesis diagnóstica de lipoma. Por lo tanto, basándonos en la anamnesis y los hallazgos clínicos, decidimos realizar una biopsia excisional para confirmar el diagnóstico. Con los resultados de la biopsia se confirmó la hipótesis diagnóstica, por lo que no hubo necesidad de tratamiento adicional. Por lo tanto, a partir de este caso podemos ver que el lipoma puede ser una lesión que puede durar varios años sin mayores complicaciones, sin embargo, puede alcanzar grandes dimensiones y en estos casos es necesario el tratamiento quirúrgico.

Immunoexpression of proliferation and apoptosis markers in oral vascular anomalies.

The biological behavior of lesions is highly dependent on the imbalance between their proliferative and apoptotic capacity. This study evaluated a correlation between the proliferative and apoptotic rates of different oral vascular anomalies (VAs) by analyzing the immunoexpression of proliferation (Ki-67) and apoptosis (Bcl-2 and Bax) markers in endothelial cells of 20 cases of GLUT-1 positive infantile hemangiomas (IHs), 20 cases of pyogenic granulomas (PGs) and 20 cases of vascular malformations (VMs). Immunoexpression analysis of Ki-67, Bcl-2 and Bax revealed a lower median percentage of positive cells in VMs cases compared to IHs and PGs cases (P <0.001). The Wilcoxon signed-rank test showed significantly higher percentages of immunostaining for Bax than for Bcl-2 in IHs (P = 0.048). In the group of PGs, a positive correlation was observed between the immunoexpressions of Ki-67 and Bax (r = 0.476; P = 0.034). Although oral IHs, PGs and VMs present similar clinical and histopathological features, each of these lesions has its etiopathogenic particularities. The results of this study suggest that different biological behaviors of VAs may be related to differences in the proliferative and apoptotic profiles of their endothelial cells.

Immunoexpression of proliferation and apoptosis markers in oral vascular anomalies

Abstract The biological behavior of lesions is highly dependent on the imbalance between their proliferative and apoptotic capacity. This study evaluated a correlation between the proliferative and apoptotic rates of different oral vascular anomalies (VAs) by analyzing the immunoexpression of proliferation (Ki-67) and apoptosis (Bcl-2 and Bax) markers in endothelial cells of 20 cases of GLUT-1 positive infantile hemangiomas (IHs), 20 cases of pyogenic granulomas (PGs) and 20 cases of vascular malformations (VMs). Immunoexpression analysis of Ki-67, Bcl-2 and Bax revealed a lower median percentage of positive cells in VMs cases compared to IHs and PGs cases (P <0.001). The Wilcoxon signed‐rank test showed significantly higher percentages of immunostaining for Bax than for Bcl‐2 in IHs (P = 0.048). In the group of PGs, a positive correlation was observed between the immunoexpressions of Ki-67 and Bax (r = 0.476; P = 0.034). Although oral IHs, PGs and VMs present similar clinical and histopathological features, each of these lesions has its etiopathogenic particularities. The results of this study suggest that different biological behaviors of VAs may be related to differences in the proliferative and apoptotic profiles of their endothelial cells.

Resumo O comportamento biológico das lesões é altamente dependente do desequilíbrio entre sua capacidade proliferativa e apoptótica. Neste estudo, avaliou-se se existe correlação entre as taxas proliferativas e apoptóticas de diferentes anomalias vasculares orais (AVs) analisando a imunoexpressão de marcadores de proliferação (Ki-67) e apoptose (Bcl-2 e Bax) em células endoteliais de 20 casos de hemangiomas infantis GLUT-1 positivos (HIs), 20 casos de granulomas piogênicos (GPs) e 20 casos de malformações vasculares (MVs). A análise de imunoexpressão de Ki-67, Bcl-2 e Bax revelou uma porcentagem mediana menor de células positivas nos casos de MVs em comparação aos casos de HIs e GPs (P <0,001). O teste de Wilcoxon mostrou porcentagens significativamente maiores de imunocoloração para Bax do que para Bcl-2 em HIs (P = 0,048). No grupo dos GPs, foi observada correlação positiva entre as imunoexpressões de Ki-67 e Bax (r = 0,476; P = 0,034). Embora HIs, GPs e MVs orais apresentem características clínicas e histopatológicas muito semelhantes, cada uma dessas lesões tem suas particularidades etiopatogênicas. Os resultados deste estudo sugerem que diferentes comportamentos biológicos dos AVs podem estar relacionados a diferenças nos perfis proliferativo e apoptótico de suas células endoteliais.

ING3 and ING4 immunoexpression and their relation to the development of benign odontogenic lesions.

The Inhibitor of Growth (ING) gene family is a group of tumor suppressor genes that play important roles in cell cycle control, senescence, DNA repair, cell proliferation, and apoptosis. However, inactivation and downregulation of these proteins have been related in some neoplasms. The present study aimed to evaluate the immunohistochemical profiles of ING3 and ING4 proteins in a series of benign epithelial odontogenic lesions. METHODS: The sample comprised of 20 odontogenic keratocysts (OKC), 20 ameloblastomas (AM), and 15 adenomatoid odontogenic tumors (AOT) specimens. Nuclear and cytoplasmic immunolabeling of ING3 and ING4 were semi-quantitatively evaluated in epithelial cells of the odontogenic lesions, according to the percentage of immunolabelled cells in each case. Descriptive and statistics analysis were computed, and the p-value was set at 0.05. RESULTS: No statistically significant differences were found in cytoplasmic and nuclear ING3 immunolabeling among the studied lesions. In contrast, AOTs presented higher cytoplasmic and nuclear ING4 labeling compared to AMs (cytoplasmic p-value = 0.01; nuclear p-value < 0.001) and OKCs (nuclear p-value = 0.007). CONCLUSION: ING3 and ING4 protein downregulation may play an important role in the initiation and progression of more aggressive odontogenic lesions, such as AMs and OKCs.

ING3 and ING4 immunoexpression and their relation to the development of benign odontogenic lesions

Abstract The Inhibitor of Growth (ING) gene family is a group of tumor suppressor genes that play important roles in cell cycle control, senescence, DNA repair, cell proliferation, and apoptosis. However, inactivation and downregulation of these proteins have been related in some neoplasms. The present study aimed to evaluate the immunohistochemical profiles of ING3 and ING4 proteins in a series of benign epithelial odontogenic lesions. Methods: The sample comprised of 20 odontogenic keratocysts (OKC), 20 ameloblastomas (AM), and 15 adenomatoid odontogenic tumors (AOT) specimens. Nuclear and cytoplasmic immunolabeling of ING3 and ING4 were semi-quantitatively evaluated in epithelial cells of the odontogenic lesions, according to the percentage of immunolabelled cells in each case. Descriptive and statistics analysis were computed, and the p-value was set at 0.05. Results: No statistically significant differences were found in cytoplasmic and nuclear ING3 immunolabeling among the studied lesions. In contrast, AOTs presented higher cytoplasmic and nuclear ING4 labeling compared to AMs (cytoplasmic p-value = 0.01; nuclear p-value < 0.001) and OKCs (nuclear p-value = 0.007). Conclusion: ING3 and ING4 protein downregulation may play an important role in the initiation and progression of more aggressive odontogenic lesions, such as AMs and OKCs.

Resumo Objetivos: A família dos Genes Inibidores de Crescimento (ING) é um grupo de genes supressores tumorais que desempenham papéis importantes no controle do ciclo celular, na senescência, no reparo do DNA, na proliferação celular e na apoptose. No entanto, a inativação e a regulação negativa dessas proteínas têm sido relacionadas em algumas neoplasias. O objetivo do presente estudo foi avaliar o perfil imuno-histoquímico das proteínas ING3 e ING4 em uma série de lesões odontogênicas epiteliais benignas. Métodos: A amostra foi composta por espécimes de 20 ceratocistos odontogênicos (CO), 20 ameloblastomas (AM) e 15 tumores odontogênicos adenomatoides (TOA). A imunoexpressão nuclear e citoplasmática de ING3 e ING4 foram avaliadas semi-quantitativamente nas células epiteliais das lesões odontogênicas, de acordo com a porcentagem de células imunomarcadas em cada caso. As análises descritivas e estatísticas foram computadas, e o valor de p estabelecido foi de 0,05. Resultados: Não foram encontradas diferenças estatisticamente significativas na imunoexpressão citoplasmática e nuclear de ING3 entre as lesões estudadas. Em contrapartida, os TOAs apresentaram maior marcação citoplasmática e nuclear de ING4 em comparação aos AMs (valor de p citoplasmático=0,01; valor de p nuclear <0,001) e COs (valor nuclear de p=0,007). Conclusão: A regulação negativa das proteínas ING3 e ING4 pode desempenhar um papel importante na iniciação e na progressão de lesões odontogênicas mais agressivas, como AMs e COs.

A 46-Year Retrospective Study of Oral Vascular Anomalies in a Brazilian Population

ABSTRACT: A retrospective study was performed to describe the demographic and clinicopathological characteristics of cases of vascular anomalies in a Brazilian population. The data of cases diagnosed as vascular anomalies over a period of 46 years, were retrieved from the archives of the Pathological Anatomy Service of the Department of Dentistry of Federal University of Rio Grande do Norte. Information about sex, age, race, diagnosis, location, and clinical characteristics was extracted. A database was created for analysis in the SPSS system and description of the results. The sample consisted of 597 cases categorized as follows: pyogenic granuloma (n = 454), infantile hemangioma (n = 57), vascular malformation (n = 37), lymphangioma (n = 20), hemangiolymph angioma (n = 10), vascular thrombus (n = 7), hemangio endothelioma (n = 5), angiofibroma (n = 1), hemangioendothelio sarcoma (n = 1), and Kaposi sarcoma (n = 5). Overall, there was a predominance of females (64.2 %), white race (54.2 %), and patients in the 3rd and 4th decades of life. Most cases affected the gingiva/ ridge (44.75 %), had a red/reddish color (60.07 %), sessile implantation (52.4 %), soft consistency (52.7 %) and nodular appearance (53, 9 %), and were non-hemorrhagic (51.3 %) and asymptomatic (76.6 %). The demographic and clinicopathological findings obtained for most of the vascular lesions analyzed are similar to those reported in published studies involving other populations. Knowledge of the particularities of these disorders is important for appropriate diagnosis and treatment decision.

RESUMEN: Se realizó un estudio retrospectivo para describir las características demográficas y clínico-patológicas de casos de anomalías vasculares en una población brasileña. Los datos de los casos diagnosticados como anomalías vasculares durante un período de 46 años, fueron obtenidos de los archivos del Servicio de Anatomía Patológica del Departamento de Odontología de la Universidade Federal de Rio Grande do Norte. Se analizó la información de sexo, edad, raza, diagnóstico, ubicación y características clínicas, y se creó una base de datos para análisis en el sistema SPSS y descripción de los resultados. La muestra consistió de 597 casos categorizados de la siguiente manera: granuloma piógeno (n = 454), hemangioma infantil (n = 57), malformación vascular (n = 37), linfangioma (n = 20), hemangiolinfangioma (n = 10), trombo vascular (n = 7), hemangioendotelioma (n = 5), angiofibroma (n = 1), hemangioendoteliosarcoma (n = 1) y sarcoma de Kaposi (n = 5). En general predominaron las mujeres de raza blanca (64,2 %), (54,2 %), y pacientes en la 3ª y 4ª década de la vida. La mayoría de los casos afectaban la encía / cresta (44,75 %), tenían un color rojo / rojizo (60,07 %), implantación sésil (52,4 %), consistencia blanda (52,7 %) y apariencia nodular (53,9 %), no hemorrágicos (51,3 %) y asintomáticos (76,6 %). Los hallazgos demográficos y clínico-patológicos de la mayoría de las lesiones vasculares analizadas son similares a los reportados en la literatura de otras poblaciones. El conocimiento de las particularidades de estos trastornos es importante para el diagnóstico y la decisión de tratamientos adecuados.

Diagnostic challenge of T-cell MALT lymphoma in oral cavity.

Mucosa-associated lymphoid tissue lymphoma (MALT) is a neoplasm of B cells from the extranodal marginal zone and a non-Hodgkin lymphoma subtype. We report a case of MALT lymphoma in the hard palate in a 74-year-old woman with the previous diagnosis of lymphoid hyperplasia. The intetion about this letter is to show the appropriate clinical conduct and the diagnostic challenge about this pathlogy in oral cavity, stressing the importance to incisional biopsy and immunohistochemical analysis to guide the right diagnostic of this rare lesion.

An update of 77 cases diagnosed as oral hemangiomas based on GLUT-1 positivity.

OBJECTIVES: To evaluate cases diagnosed as "oral hemangiomas" based on the immunohistochemical expression of human glucose transporter protein (GLUT-1) and on histopathological features, and to investigate whether the classification proposed by the ISSVA was used correctly to classify these lesions. MATERIAL AND METHODS: All cases stored in the archives of an Oral Pathology Service and diagnosed as "oral hemangiomas" were reviewed. Seventy-seven cases were analyzed regarding the expression of GLUT-1. GLUT-1(+) specimens were classified as true infantile hemangioma (IH) and GLUT-1(-) specimens were reclassified based on their histopathological features. The nomenclature of these lesions was evaluated and some cases were reclassified. RESULTS: Only 26 (33.8%) of the specimens were indeed IHs. Among the GLUT-1(-) specimens, 20 (26.0%) were reclassified as pyogenic granulomas (PGs) and 31 (40.2%) as vascular malformations. Considering the previously applied nomenclature, only 47.5% of the cases initially diagnosed as "hemangiomas" were IHs. In the group of "capillary hemangiomas", most cases (56.2%) were PGs. Among the three "cellular hemangiomas", two were PGs and one was IH. Most (88.8%) "cavernous hemangiomas" were vascular malformations. CONCLUSION: Careful and parameterized review of cases of vascular anomalies is necessary using auxiliary tools such as GLUT-1, since the exclusive use of histopathological findings might be insufficient to differentiate some anomalies. CLINICAL RELEVANCE: Accurate clinical examination and the use of biomarkers such as GLUT-1 are essential for the diagnosis.

Hiperplasia angiolinfoide com eosinofilia: um caso raro em cavidade oral / Angiolymphoid hyperplasia with eosinophilia: a rare case in the oral cavity

Resumo A hiperplasia angiolinfoide com eosinofilia (HALE) é considerada uma lesão vascular benigna rara que acomete, principalmente, o tecido cutâneo e subcutâneo da região de cabeça e pescoço, mas incomum na cavidade oral. Sua etiopatogenia permanece indefinida, sendo descrita como proliferação vascular reacional, malformação vascular ou neoplasia. Tem como principal diagnóstico diferencial a doença de Kimura. Este trabalho relata um caso de um paciente do sexo masculino, de 50 anos, que exibia aumento de volume nodular na mucosa do lábio superior, com 3 cm de dimensão e 7 anos de evolução. Após a biópsia excisional, o exame histopatológico mostrou lesão bem encapsulada multilobulada com proliferação de capilares sanguíneos com células endoteliais de aspecto epitelioide, infiltrado inflamatório difuso com linfócitos, plasmócitos, inúmeros eosinófilos e presença de folículos linfoides. A análise imuno-histoquímica revelou positividade para CD34 e Ki-67, o que, juntamente com o exame morfológico, direcionou o diagnóstico para HALE.

Abstract Angiolymphoid Hyperplasia with eosinophilia (ALHE) is considered a rare, benign vascular lesion that mainly affects the skin and subcutaneous tissues of the head and neck, but is uncommon in the oral cavity. Its etiology remains unclear and it has been described as a reactive vascular proliferation, vascular malformation or neoplasm. Kimura's disease is the primary entity to consider in differential diagnosis. Here we report on a rare case of ALHE involving the upper lip of a 50-year-old male patient that had a nodular swelling with approximately 3 cm, 7 years after initial onset. An excisional biopsy was performed and histopathologic examination revealed a well-encapsulated, multi-lobed lesion with proliferation of blood capillaries, displaying endothelial cells of epithelioid appearance, diffuse inflammatory infiltrate with lymphocytes, plasma cells, numerous eosinophils, and presence of lymphoid follicles. Immunohistochemical tests were positive for the markers CD34 and Ki-67 that, in combination with the results of morphological examination, were suggestive of a diagnosis of ALHE.

Study of the participation of MMP-7, EMMPRIN and cyclophilin A in the pathogenesis of periodontal disease.

BACKGROUND AND OBJECTIVE: Periodontal disease is an infectious disease resulting from the immunoinflammatory response of the host to microorganisms present in the dental biofilm which causes tissue destruction. The objective of this study was to evaluate the immunohistochemical expression of matrix metalloproteinase 7 (MMP-7), extracellular matrix metalloproteinase inducer (EMMPRIN) and cyclophilin A (CypA) in periodontal disease. DESIGN: Gingival tissue samples were divided as follows: clinically healthy gingiva (n=32), biofilm-induced gingivitis (n=28), and chronic periodontitis (n=30). Histological sections of 3µm were submitted to immunoperoxidase method and undergone quantitative analysis. The results were analyzed statistically by the Mann-Whitney and Spearman correlation tests, with the level of significance set at 0.05 (α=0.05). RESULTS: Immunopositivity for MMP-7, EMMPRIN and CypA differed significantly between the three groups, with higher percentages of staining in chronic periodontitis specimens, followed by chronic gingivitis and healthy gingiva specimens (p<0.05). Immunoexpression of CypA and MMP-7 was higher in the intense inflammatory infiltrate observed mainly in cases of periodontitis (p<0.05). CypA expression was positively correlated with MMP-7 (r=0.831; p<0.001) and EMMPRIN (r=0.289; p=0.006). In addition, there was a significant positive correlation between probing depth and expression of MMP-7 (r=0.726; p<0.001), EMMPRIN (r=0.345; p=0.001), and CypA (r=0.803; p<0.001). CONCLUSION: These results suggest that MMP-7, EMMPRIN and CypA are associated with the pathogenesis and progression of periodontal disease.

Osteoblastoma in the retromolar region: a case report / Osteoblastoma em região retromolar: relato de caso

ABSTRACT Osteoblastoma is a rare benign tumor that accounts for less than 1% of all bone tumors. About 10% of osteoblastomas are found in the skull bones and almost half of these cases involve the mandible, especially the posterior segments. This report describes the case of a 27-year-old female patient with a unilocular radiopaque expansive lesion in the left mandible, which had well-delimited margins and caused mild bone expansion. Microscopic analysis revealed the presence of mineralized material in the form of irregularly arranged vital trabeculae at different stages of mineralization. Osteocytes were trapped inside these trabeculae, which contained osteoclast-like multinucleated cells and voluminous pavement cells with hyperchromatic nuclei, sometimes interpreted as osteoblasts. Many bone-producing lesions have clinical, radiologic and histopathologic features that resemble osteoblastoma. The understanding and correlation of these findings are extremely important since they contribute to the correct diagnosis and appropriate treatment of this rare entity, improving its prognosis.

RESUMO Osteoblastoma é um tumor benigno raro que representa menos de 1% de todos os tumores ósseos e 10% estão localizadas nos ossos do crânio e quase metade destes casos afeta a mandíbula, especialmente os segmentos posteriores. Este relato descreve um caso de uma lesão radiopaca unilocular expansiva na mandíbula esquerda, com margens bem delimitadas, causando expansão discreta do osso em um paciente do sexo feminino de 27 anos de idade. O exame microscópico revelou presença de material mineralizado na forma de trabéculas vitais com diferentes estágios de mineralização dispostas irregularmente e exibindo osteócitos aprisionados em seu interior, células multinucleadas semelhantes a osteoclastos e pavimentação células volumosas que têm núcleos hipercromáticos, por vezes interpretados como osteoblastos. Muitas lesões produtoras de osso possuem características clínicas, radiológicas ou histopatológicas semelhantes ao osteoblastoma. Compreender e correlacionar todos esses achados é de extrema importância, uma vez que auxilia no correto diagnóstico adequado tratamento desta entidade rara, levando a um bom prognóstico.

Correlation between cell cycle proteins and hMSH2 in actinic cheilitis and lip cancer.

This study aims to evaluate and verify the relationship between the immunoexpression of hMSH2, p53 and p21 in actinic cheilitis (AC) and lower lip squamous cell carcinoma (SCC) cases. Forty AC and 40 SCC cases were submitted to immunoperoxidase method and quantitatively analyzed. Expression was compared by Mann-Whitney test, Student t test or one-way ANOVA. To correlate the variables, Pearson's correlation coefficient was calculated. The expression of p53 and p21 showed no significant differences between histopathological grades of AC or lower lip SCC (p > 0.05). Immunoexpression of p53 was higher in SCC than in AC (p < 0.001), while p21 expression was more observed in AC when compared to SCC group (p = 0.006). The AC group revealed an inverse correlation between p53 and hMSH2 expression (r = -0.30, p = 0.006). Alterations in p53 and p21 expression suggest that these proteins are involved in lower lip carcinogenesis. Moreover, p53 and hMSH2 seem to be interrelated in early events of this process.