Oral and oropharyngeal lymphomas: A multi-institutional collaborative study.

BACKGROUND: Lymphomas in the oral and oropharyngeal regions are relatively uncommon, and their diagnosis is challenging and complex due to the myriad histopathological subtypes. Herein, we report a large series of oral and oropharyngeal lymphomas and compare our data with the currently available literature. METHODS: All cases diagnosed as lymphomas affecting the oral and oropharyngeal regions were retrospectively retrieved from seven Brazilian institutions. Clinicodemographic data and histopathological features were evaluated and described, while a comprehensive literature review was undertaken in order to compare our findings. RESULTS: A total of 304 cases of oral and oropharyngeal lymphomas were obtained, mostly affecting individuals aged 60-69 years (n = 68) with a mean age at diagnosis of 54.2 ± 20.1 years. Males and females were equally affected. Mature B-cell neoplasms (87.2%) were the most common group, followed by mature T- and NK-cell neoplasms (11.2%) and precursor lymphoid neoplasms (1.6%). The most frequent subtypes in each group were diffuse large B-cell lymphomas, not otherwise specified (n = 99), extranodal NK/T-cell lymphomas, nasal type (n = 12), and B-lymphoblastic leukaemia/lymphomas, not otherwise specified (n = 4). The most commonly involved sites were the palate (26.3%), mandible (13%), and maxilla (10.5%). CONCLUSION: Diffuse large B-cell lymphoma, not otherwise specified, remains the most common subtype of lymphomas in the oral and oropharyngeal region. Older patients are the most affected, with no gender predilection and the palate and jaw are usually affected.

Periodontal growth in areas of vascular malformation in patients with Sturge-Weber syndrome: a management protocol.

Sturge-Weber syndrome (SWS) is a very rare condition characterized by abnormal vascular formations that encompass several manifestations: cutaneous, neurologic, ocular, and oral. Neurologic conditions are the most important factor, especially epilepsy, which frequently leads patients to make use of anticonvulsants. These drugs are capable of inducing abnormal tissue growth in the oral cavity that can be situated over areas with vascular malformation, requiring special attention by the clinician. This report describes 1 case of SWS and performs a literature review of treatments for this condition, providing a protocol of treatment for these clinical situations.

Calvarial autogenous bone graft for maxillary ridge and sinus reconstruction for rehabilitation with dental implants.

Autogenous bone grafting is the gold-standard technique for bone augmentation procedures prior to implant placement. If the amount of available intraoral donor bone is insufficient, it is necessary to harvest bone graft from extraoral sites, such as calvaria. Although this technique is well established, only a few case reports show the histological analysis of the grafted bone at the moment of implant placement. This article reports the case of a 48-year-old female patient with a critical atrophic maxillary ridge reconstructed using autogenous calvarial bone graft prior to implant placement, with clinical and histological evaluation. Bone was collected under general anesthesia from the parietal bone. The outer cortical originated the bone blocks, and the medullar bone layer between was collected to be used in the sinus augmentation procedure, together with 5 of the bone blocks triturated. Six months after bone augmentation, 8 implants were placed in the grafted area and 2 biopsies were retrieved (anterior and the posterior regions), allowing the visualization of the bone-remodeling process in the grafted areas. The patient had a stable recovery. Our results showed that although necrotic bone could still be seen in the outer layer of the grafted area, the interface between this necrotic bone and the already remodeled bone was consistent with biocompatibility. Two-year radiographic evaluation showed success of the grafts and the implants in supporting an esthetic and functionally stable prosthesis. Summarizing, calvarial bone grafts are a viable alternative for the attainment of adequate bone volume prior to implant placement.

Experimental development of bisphosphonate-related osteonecrosis of the jaws in rodents.

Osteonecrosis of the jaw (ONJ) following the use of bisphosphonates has become of increased interest in the scientific community, due in particular to its as-yet-unsolved pathogenesis. An experimental model of ONJ was induced in normal male rats [alendronate (ALN); 1 mg/Kg/day; n = 10] and matched controls (saline solution; n = 10). After 60 days of drug treatment, all animals were subjected to extractions of the left first lower molars and were euthanized at 3 and 28 days postsurgery. The following analyses were performed: (i) descriptive and quantitative (scores) histological evaluation, (ii) stereometry of distal sockets and (iii) biochemical measurement of C-telopeptide cross-linked collagen type I (CTX) and bone-specific alkaline phosphatase (BALP). The results showed that 28 days postsurgery the animals treated with ALN had areas of exposed and necrotic bone, associated with significant infection, especially in the interalveolar septum area and crestal regions, compared with controls. The levels of CTX, BALP and bone volume, as well as the degrees of inflammation and vascularization, were significantly reduced in these animals. Therefore, analysis of the data presented suggests that ALN therapy is associated with the development of osteonecrosis in the jaws of rodents after tooth extraction.

Acesso cirúrgico ao segmento cervical distal da artéria carótida interna e à bifurcação carotídea alta - revisão integrativa da literatura e proposta de protocolo / Surgical access to the distal cervical segment of the internal carotid artery and to a high carotid bifurcation - integrative literature review and protocol proposal

Resumo Diversas manobras já foram descritas para o acesso ao segmento distal cervical da artéria carótida interna ou à bifurcação carotídea alta; entretanto, há divergências na sistematização dessas técnicas. O objetivo deste estudo é revisar as técnicas descritas e propor um protocolo prático que auxilie na seleção da técnica mais adequada para cada caso. Para isso, foi realizada uma busca nas bases de dados PubMed Central, Biblioteca Virtual em Saúde e SciELO por artigos sobre o tema, em língua inglesa ou portuguesa, publicados entre os anos de 1980 e 2021. Entre as manobras descritas, parece razoável que as duas etapas iniciais sejam a abordagem ao músculo esternocleidomastóideo, seguida pela secção/retração do ventre posterior do músculo digástrico. Caso necessário, a subluxação mandibular temporária unilateral é um recurso adicional e preferível à divisão do aparato estiloide, devido ao menor potencial de morbidade. Exposições ainda mais amplas podem ser obtidas com as osteotomias mandibulares.

Abstract Several different maneuvers have been described for obtaining access to the distal cervical segment of the internal carotid artery or to a high carotid bifurcation. However there are different approaches to systematization of these techniques. The objective of this study is to review the techniques described and propose a practical protocol to support selection of the most appropriate technique for each case. The review is based on the results of database searches on PubMed Central, the Virtual Health Library (BVSalud), and SciELO for articles on the subject published in English or Portuguese from 1980 to 2021. Among the different maneuvers described, it appears reasonable that the first two steps should be to obtain access at the sternocleidomastoid muscle, followed by section or retraction of the digastric muscle posterior belly. If needed, temporary unilateral mandibular subluxation is an additional resource that is preferable to division of the styloid apparatus process, because of its lesser potential for morbidity. Even wider exposure can be obtained using mandibular osteotomies.

Tratamento conservador de osteomielite em mandibula: relato de caso / Conservative treatment osteomyelitis in jaw: case report / Tratamiento conservador de osteomielita en mandible: reporte de caso

Introdução: As infecções nos ossos de face podem acometer os maxilares, geralmente a mandíbula, apresentando diversos fatores etiológicos, além de seu potencial multibacteriano. Embora tratamentos mais radicais possam ser uma escolha preferencial, meios conservadores podem surgir como alternativa afim de evitar tratamento mais agressivo aos pacientes. Relato de caso: Paciente do sexo feminino, 17 anos de idade, vítima de acidente náutico foi submetido a tratamento cirúrgico para osteossíntese de fratura complexa de mandíbula e após um período de 30 dias houve evolução de um quadro de osteomielite em região mandibular no qual foi preconizado tratamento conservador com antibioticoterapia e orientações de restrição de dieta líquida e pastosa. No período de proservação de 06 meses observou se melhora e regressão considerável do quadro infeccioso onde houve continuidade do acompanhamento de 01 ano sem sinais sugestivos de recidiva. Considerações Finais: O tratamento conservador deve ser considerado como importante alternativa nos casos de osteomielite nas complicações pós-operatórias de fixação de fraturas do complexo maxilo-mandibular... (AU)

Introduction: Infections is commonly affect in jaws and usually the mandibular bone present several etiological factors and in addition to their multibacterial potential. Although radical treatments may be preferred choices another treatments can be emerge as a new way to prevent treatment from becoming more aggressive to pacients. Case Report: A 17-year-old female patient victim of a nautical accident, underwent surgery treatment for complex fracture osteosynthesis and after a while appear osteomyelitis in mandibular bone in which conservative treatment was recommended with antibiotherapy and guidelines for restricting liquid and pasty diet. During 06 months improvement and considerable regression of the infect condition was observed with 01 year of preservation without signs of reccurrence. Final considerations: Conservative treatment should be considered na important alternative in cases of osteomyelitis in post operative complications of fixation of fractures in jaws... (AU)

Las infecciones en los huesos faciales pueden afectar el maxilar, generalmente la mandíbula, presentando varios factores etiológicos, además de su potencial multibacteriano. Aunque los tratamientos más radicales pueden ser una opción preferida, los medios conservadores pueden surgir como una alternativa para evitar un tratamiento más agresivo para los pacientes Caso clínico: Paciente de sexo femenino de 17 años, víctima de accidente náutico, sometida a tratamiento quirúrgico por osteosíntesis de una fractura compleja de mandíbula y al cabo de 30 días evolucionó una osteomielitis en la región mandibular en la que se Fue un tratamiento conservador con antibioticoterapia y se recomendaron pautas para restringir las dietas líquidas y pastosas. En el período de seguimiento de 06 meses, hubo una mejoría considerable y regresión de la condición infecciosa, donde hubo una continuación del seguimiento de 01 año sin signos sugestivos de recurrencia. Consideraciones finales: El tratamiento conservador debe considerarse como una alternativa importante en casos de osteomielitis en complicaciones postoperatorias de fijación de fracturas del complejo maxilomandibular... (AU)

Effects of chronic stress and alendronate therapy on the osseointegration of titanium implants.

PURPOSES: The purposes of this study were to evaluate the influence of chronic stress (CS) on implant osseointegration and also to analyze whether alendronate (ALN) therapy could prevent these eventual stress-negative effects. MATERIALS AND METHODS: Adult male Holtzmann rats were assigned to one of the four experimental groups: AL (ALN; 1 mg/kg/week; n = 12), ALS (ALN + CS; 1 mg/kg/week; n = 12), CTL (sterile physiological saline; n = 12), or CTLS (sterile physiological saline + CS; n = 12). After 58 days of drug therapy, the ALS and CTLS groups were exposed to CS, and 2 days later all animals underwent tibial implant installation. The animals were euthanized 28 days following the operative surgical procedure. RESULTS: It was observed that the CTLS group presented an impairment of bone metabolism represented by lowest levels of bone-specific alkaline phosphatase and bone area fraction occupancy values. Furthermore, these animals presented a higher proportion of empty osteocytic lacunae. In contrast, the ALN therapy showed increased osseointegration and torque value parameters, regardless of stress exposition. CONCLUSIONS: Analysis of the data presented suggests that CS partially impairs the osseointegration of tibial implants and that ALN therapy is able to prevent these negative effects.

Epidemiological aspects of rheumatoid arthritis patients affected by oral bisphosphonate-related osteonecrosis of the jaws.

This literature review aims to evaluate the epidemiologic profile of patients with rheumatoid arthritis (RA) that developed a bisphosphonate-related osteonecrosis that affect the jaws (BRONJ), including demographic aspects, as well as clinical and therapeutic issues. A search of PUBMED/MEDLINE, Scopus, and Cochrane databases from January 2003 to September 2011 was conducted with the objective of identifying publications that contained case reports regarding oral BRONJ in RA patients. Patients with RA who develop oral BRONJ are usually women above 60 years taking steroids and long-term alendronate. Most of them have osteoporosis, and lesions, triggered by dental procedures, are usually detected at stage II in the mandible. Although there is no accepted treatment protocol, these patients seem to have better outcomes with conservative approaches that include antibiotic therapy, chlorhexidine, and drug discontinuation.

Long-term treatment with alendronate increases the surgical difficulty during simple exodontias - an in vivo observation in Holtzman rats.

BACKGROUND: Atraumatic teeth extractions protocols are highly encouraged in patients taking bisphosphonates (Bps) to reduce surgical trauma and, consequently, the risk of jaws osteonecrosis development. In this way, this paper aims to report the findings of increased surgical difficulty during simple exodontias in animals treated with bisphosphonates. METHODS: Sixty male Holtzman rats were randomly distributed into three groups of 20 animals and received daily subcutaneous administration of 1 mg/kg (AL1) or 3 mg/kg (AL3) of alendronate or saline solution (CTL). After 60 days of drug therapy all animals were submitted to first lower molars extractions under general anesthesia. Operatory surgical time and the frequency of teeth fractures were measured as principal outcomes and indicators of surgical difficulty degree. RESULTS: Animals treated with alendronate (AL1 and AL3) were associated to higher operatory times and increased frequency of teeth fractures compared to match controls. CONCLUSIONS: The bisphosphonate therapy may be associated with an increased surgical difficulty and trauma following simple exodontias protocols, which is considered a critical issue when it comes to osteonecrosis development.

Efficacy of lumiracoxib versus diclofenac sodium in pain control following extraction of impacted lower third molar / Eficacia de lumiracoxib frente a diclofenaco de sodio en el control del dolor después de la extracción de un tercer molar inferior impactado

The aim of this paper was to compare the efficacy of two different anti-inflammatory agents, Diclofenac (Deltaflogin®) and Lumiracoxib (Prexige®) in the control of postoperative pain that results from surgical removal of impacted lower third molars. Twenty adult patients from the Oral and Maxillofacial Surgery Division of the Araraquara Dentistry School, UNESP who presented bilateral impacted lower third molars were included in the study. Removal of the impacted teeth was performed in each side in different operative moments in a split mouth design for the study. The anti-inflammatory drugs evaluated were randomly administered on the first and second surgical procedures. The pain level was recorded using an analogical visual scale at 6, 24, 48 and 72 hours after surgical intervention. Both lumiracoxib 400 mg and diclofenac 100 mg are efficient for acute pain control after surgical removal of impacted lower third molars. However, lumiracoxib offered better pain control.

El objetivo de este trabajo fue comparar la eficacia de dos agentes antiinflamatorios distintos, Diclofenaco (Deltaflogin®) y Lumiracoxib (Prexige®) en el control del dolor postoperatorio resultante de la extracción quirúrgica de terceros molares inferiores impactados. Fueron incluídos, veinte pacientes adultos de la División de Cirugía Oral y Maxilofacial de la Escuela de Odontología de Araraquara, UNESP que presentaron terceros molares inferiores impactados. La extracción de los dientes impactados se realizó en distintos tiempos operatorios a cada lado en un diseño de estudio de boca dividida. Los antinflamatorios evaluados fueron administrados de forma aleatoria en el primer y segundo procedimento quirúrgico. El nivel de dolor se registró utilizando una escala visual análoga a las 6, 24, 48 y 72 horas después de la intervención. Ambos; lumiracoxib 400 mg y diclofenaco 100 mg son eficientes para el control del dolor agudo, después de la extracción quirúrgica de terceros molares inferiores impactados. Sin embargo, lumiracoxib ofreció mejor control del dolor.

Oral bisphosphonate-related osteonecrosis of the jaws in rheumatoid arthritis patients: a critical discussion and two case reports.

BACKGROUND: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a clinical condition characterized by the presence of exposed bone in the maxillofacial region. Its pathogenesis is still undetermined, but may be associated with risk factors such as rheumatoid arthritis (RA). The aim of this paper is to report two unpublished cases of BRONJ in patients with RA and to conduct a literature review of similar clinical cases with a view to describe the main issues concerning these patients, including demographic characteristics and therapeutic approaches applied. METHODS: Two case reports of BRONJ involving RA patients were discussed RESULTS: Both patients were aging female taking alendronate for more than 3 years. Lesions were detected in stage II in posterior mandible with no clear trigger agent. The treatment applied consisted of antibiotics, oral rinses with chlorhexidine, drug discontinuation and surgical procedures. Complete healing of the lesions was achieved. CONCLUSIONS: This paper brings to light the necessity for rheumatologists to be aware of the potential risk to their patients of developing BRONJ and to work together with dentists for the prevention and early detection of the lesions. Although some features seem to link RA with oral BRONJ and act as synergistic effects, more studies should be developed to support the scientific bases for this hypothesis.

Experimental osteonecrosis: development of a model in rodents administered alendronate

Abstract The main objective of this study was to cause bisphosphonate-related osteonecrosis of the jaws to develop in a rodent model. Adult male Holtzman rats were assigned to one of two experimental groups to receive alendronate (AL; 1 mg/kg/week; n = 6) or saline solution (CTL; n = 6). After 60 days of drug therapy, all animals were subjected to first lower molar extraction, and 28 days later, animals were euthanized. All rats treated with alendronate developed osteonecrosis, presenting as ulcers and necrotic bone, associated with a significant infection process, especially at the inter-alveolar septum area and crestal regions. The degree of vascularization, the levels of C-telopeptide cross-linked collagen type I and bone-specific alkaline phosphatase, as well as the bone volume were significantly reduced in these animals. Furthermore, on radiographic analysis, animals treated with alendronate presented evident sclerosis of the lamina dura of the lower first molar alveolar socket associated with decreased radiographic density in this area. These findings indicate that the protocol developed in the present study opens new perspectives and could be a good starting model for future property design.

Osteomielitis crónica con periostitis proliferativa / Chronic osteomyelitis with proliferative periostitis

La osteomielitis crónica con periostitis proliferativa es un tipo de alteración caracterizada por una reacción periosteal exacerbada causada por un estimulo de baja intensidad, generalmente una lesión cariosa con patología periapical asociada. Actúa principalmente en niños y adolescentes con predilección por la región basilar de mandíbula. Clínicamente, se manifiesta a través de un aumento de volumen doloroso intra o extraoral, de consistencia endurecida. Radiográficamente presenta laminas óseas neoformadas, paralelas entre si con superficie cortical, observándose el aspecto típico de "cascara de cebolla". El tratamiento incluye el retiro del factor etiológico con o sin antibioterapia y posterior restablecimiento de la simetría facial del paciente. Este trabajo presenta un caso de osteomielitis crónica con periostitis proliferativa en una paciente de sexo femenino de 11 años de edad, causada por una lesión cariosa en el primer molar inferior izquierdo, quien fue sometida a exodoncia del diente comprometido con posterior restablecimiento de la simetría facial.

Chronic osteomyelitis with proliferative periostitis is a kind of osteomyelitis that is characterized by a great periosteal reaction resulting of low grade stimulation, usually a caries lesion associated a periapical pathology. It affects especially children and young adults, with the mandible as the most common site, usually in the inferior aspect. Clinically presents as a painless hard swelling intra and/or extra-oral. Radiographic aspects include bone layers new formed, parallel to each other and to the underlying cortical surface, giving the characteristic appearance of "onion skin". Treatment includes elimination of the cause, with or without antibiotics, being restored the facial symmetry of patient. The present article is a clinical case report of chronic osteomyelitis with proliferative periostitis affecting a female 11 year old patient, caused by a caries lesion in the left permanent first molar, that was submissed to a exodontia and the facial symmetry of the patient was restored with management.

Infecções bacterianas da cabeça e pescoço: estudo retrospectivo / Head and neck bacterial infections: retrospective study

Objetivos: avaliar retrospectivamente as características das infecções de origem odontogênica ou não, acometendo a região da cabeça e pescoço. Material e Métodos: por meio de uma análise retrospectiva de 50 prontuários de pacientes com diagnóstico de infecções bacterianas da cabeça e pescoço (IBCP) tratados no âmbito hospitalar pela disciplina de Cirurgia e Traumatologia Buco-Maxilo-Facial da Faculdade de Odontologia de Araraquara – UNESP, no período de 1998 a 2006, analisou-se aspectos como gênero, idade, etiologia, tempo de permanência hospitalar, sinais e sintomas, espaços fasciais envolvidos e protocolo de tratamento. Resultados: nesta pesquisa observou-se que as IBCP geralmente têm origem odontogênica (94%), do quadrante póstero-inferior (49%), por meio de lesões de cárie (66%), acometendo preferencialmente sujeitos do gênero masculino (1.6:1), acima dos 18 anos de idade. Geralmente, os pacientes apresentam-se com edema, eritema, dor, odinofagia, trismo e disfagia, permanecendo internados durante cinco dias em média. Estas infecções acometem com freqüência mais de um espaço fascial (74%), sendo o submandibular o mais envolvido (80%). São infecções de natureza polimicrobiana, com predomínio de aeróbios. O protocolo de tratamento mais empregado para estes pacientes incluiu exodontia, drenagem e antibioticoterapia, correspondendo a 94% da amostra. Optou-se pelas cefalosporinas como antibiótico para terapia empírica em 94% dos casos, utilizando associações de antimicrobianos na maior parte dos pacientes (94%). Conclusão: a maior parte das IBCP é de origem odontogênica, advinda do quadrante póstero-inferior, acometendo mais frequentemente o espaço submandibular de homens com mais de 18 anos, caracterizando-se usualmente por edema, eritema, trismo, odinofagia, disfagia e dor. O protocolo de tratamento padrão incluiu exodontia, drenagem e antibioticoterapia.

Purpose: retrospective analyze of head and neck bacterial infections by odontogenic and non-odontogenic source. Materials and Methods: a retrospective analyze of 50 records of patients with diagnosis of HNBI treated in hospital room by Department of Maxillofacial Surgery and Traumatology of Araraquara Dentistry Faculty – UNESP, between 1998 and 2006, was made analyzing issues as gender, age, etiology, length of hospital stay, symptoms and signals, fascial spaces and treatment. Results: It could be established that infections are usually originated from odontogenic causes (94%), from postero-inferior quadrant (49%) by carious lesions (66%), affecting usually males (1.6:1), above 18 years old. Patients are encountered most commonly with swelling, erythema, pain, odynophagia, trismus and dysphagia, staying in the hospital for five days in median. This infections affect most commonly multiples fascial spaces (74%), being submandibular the most affected (80%). Infections usually have both aerobic and anaerobic organisms, being aerobic the most frequent. The treatment plan most utilized for this patients are extractions, drainage and antibiotic therapy (94%). The cefalosporines were the choice for the empiric therapy (94%), utilizing antibiotic associations for the most patients (94%). Conclusion: the most of HNBI were by odontogenic source, from postero-inferior quadrant, affecting usually submandibular space of men above 18 years, characterizing usually by swelling, erythema, trismus, odynophagia, dysphagia and pain. Standard treatment was extractions, drainage and antibiotic therapy.

Adesivos de cianoacrilato para fixação de xenoenxertos / Cyanoacrylate adhesives for fixation of xenografts

O objetivo deste trabalho foi o de avaliar histologicamente os adesivos à base de etil-cianoacrilato e de butil-2-cianoacrilato na fixação de enxertos ósseos bovinos, em osso parietal de coelho. Vinte coelhos adultos receberam enxerto de osso bovino inorgânico liofilizado em bloco, sobre osso parietal. Previamente, foram realizadas osteotomias no osso bovino, com uma trefina de 6 mm. Os enxertos foram fixados com etil-cianoacrilato no grupo I (GI) e, com butil-2-cianoacrilato, no grupo II (GII). Após 5, 15, 30, 60 e 120 dias, os animais foram sacrificados, e as peças foram processadas segundo técnica histológica para coloração em H.E. Em 15 dias, em GI e GII, foram observadas discreta reação inflamatória. Notou-se presença de neoformação óssea adjacente ao enxerto em 30 dias, no GI e aos 60 dias, no GII. Aos 120 dias, tecido conjuntivo no interior do enxerto, pontos de neoformação óssea, presença de adesivo e os enxertos não se apresentaram incorporados ao leito receptor em todos os espécimes (GI e GII). Concluímos que tanto etil-cianoacrilato quanto butil-2-cianoacrilato foram biocompatíveis. Ambos os adesivos fixaram os xenoenxertos, promovendo estabilidade adequada para neoformação óssea no interior do enxerto e na interface enxerto/leito receptor, no entanto uma avaliação adicional a longo prazo é necessária para verificar a degradação completa dos adesivos.

The aim of this study was to histologically evaluate ethyl-cyanoacrylate and butyl-2-cyanoacrylate adhesives for fixation of bovine bone grafts on parietal bone of the rabbit. Twenty adult rabbits received a graft of freeze-dried inorganic bovine bone on parietal bone. Prior to the graft, osteotomies were performed on bovine bone with a 6mm-trephine. The grafts were fixed with ethyl-cyanoacrylate in group I (GI) and with butyl-2-cyanoacrylate in group II (GII). The animals were sacrificed after 5, 15, 30, 60 and 120 days and the specimens submitted to the routine laboratory procedures for H.E. staining. At 15 days, a slight inflammatory reaction was observed in both GI and GII. The presence of new bone formation around the graft was noted at 30 days in GI and at 60 days in GII. After 120 days, there was connective tissue within the graft, regions of new bone formation and presence of adhesive, none of the grafts being incorporated into the host bed in either GI or GII. We concluded that both ethyl-cyanoacrylate and butyl-2-cyanoacrylate were biocompatible and both adhesives fixed the xenografts, providing adequate stability for new bone formation inside the graft and on the graft/host bed interface. However, an additional evaluation long-term is necessary to verify the complete degradation of the adhesives.

Carcinoma mucoepidermóide de glândula sublingual: relato de caso clínico / Mucoepidermoid carcinoma of sublingual salivary gland: report of case

Os tumores das glândulas salivares maiores correspondem a aproximadamente 3 a 5% de todas as neoplasias da cabeça e pescoço. O carcinoma mucoepidermóide (CME) é o tumor maligno de glândula salivar mais frequente na cavidade bucal, ocorrendo preferencialmente no gênero feminino, entre a 3º e 4º décadas de vida. Trata-se de uma lesão agressiva, que se apresenta clinicamente por meio de um aumento de volume com aspecto nodular, de consistência sólida, fixo à palpação, variando entre as tonalidades de azul, vermelho ou púrpura. O processo diagnóstico é feito por meio de uma associação entre os exames clínico e complementar, sendo a biópsia essencial para a sua conclusão. O carcinoma mucoepidermóide pode ser classificado quanto ao seu grau de diferenciação em baixo, intermediário e alto grau. Um recente sistema utilizando cinco achados histopatológicos parece ser o ideal para realizar essa classificação. O tratamento é cirúrgico e consiste em exérese total da lesão, sendo o prognóstico favorável.

The major salivary glands tumors are 3 to 5 % of all the head and neck neoplasms. The mucoepidermoid carcinoma is a malignant tumor of salivar gland most frequent in the oral cavity, preferential in females, between 3th and 4th decades of life. One is about an aggressive injury, where the main clinical aspects include a nodular form, solid and fixed consistence increase the touch, varying among the blue shades to the red or purple. The process diagnosis is made through an association among the clinical and complemental exams, being the biopsy essential for the dignosis conclusion. The mucoepidermoid carcinoma can be classified as his differentiation degree in low, intermediate and high-grade. A recent system using five histopathological founds seems to be the ideal to accomplish that classification. Treatment usually surgical, include complete resection of the lesion, being the favorable prognostic.

Implantes dentais em pacientes com diabetes mellitus / Dental implants in patients with diabetes mellitus

Os implantes osseointegráveis representam um grande avanço da Odontologia, no que diz respeito à reabilitação de áreas edêntulas, uma vez que permite o restabelecimento estéticofuncional com previsibilidade e sucesso em longo prazo. No entanto, a efetividade deste tratamento depende do processo de osseointegração, sendo consequentemente dependente do estado de saúde geral do paciente. Sob esse aspecto, a aplicabilidade de implantes em indivíduos portadores de diabetes mellitus (DM) permanece controversa, uma vez que o estado hiperglicêmico pode representar um fator negativo para a osseointegração, conduzindo ao insucesso do tratamento. Além disso, existem fatores de risco inerentes ao diabetes que podem aumentar as taxas de insucesso na terapia com implantes dentários, permanecendo a dúvida se o diabetes seria uma contraindicação absoluta a este tipo de terapia. Dessa forma, o diabetes tem sido considerado uma contraindicação relativa para realização de implantes dentários, de modo que pacientes com controle metabólico adequado são considerados aptos a este tipo de tratamento. Em função desses questionamentos, foi realizada uma revisão da literatura sobre a aplicabilidade de implantes dentais em portadores de diabetes.

Dental implants represent a great improvement in Dentistry in respect to rehabilitation of edentulous ridges due to the functional and aesthetic reestablishment with long-term predictability and success. However, the effectiveness of this treatment relies on successful osseointegration during the healing period. In this way, the applicability of dental implants in patients with diabetes mellitus (DM) remains controversial, by the fact that the hyperglycemic status presents a negative effect on the osseointegration. It is not clear yet if the therapy with dental implants is an absolute contraindication to these patients. For this reason, the aim of the present study is to review the literature about the treatment with dental implants in patients with diabetes and to propose a protocol to perform dental implants in patients with diabetes. Diabetes has been considered a relative contraindication to dental implants, as the patients with adequate metabolic control can be treated with this kind of therapy, because inadequate metabolic control can lead to the failure of the treatment. Besides, there are risk factors for the diabetic implant patient that may decrease the success rates of dental implants therapy. In this way, the dentist should understand all the relevant implications before considering the indication of dental implants to patients with diabetes. It is important to have more controlled studies to evaluate the effects of diabetes on the implant-tissue interface and further investigations are necessary in order to elucidate the role of insulin and molecular mechanisms that might interfere on the osseointegration in patients with diabetes.

Implantes curtos / Short implants - review

O avanço tecnológico na Implantodontia contemporânea tem facilitado o processo de reabilitação oral dos pacientes parcialmente ou totalmente edêntulos. Por outro lado, acidentes anatômicos, como a presença do seio maxilar e do canal mandibular na região posterior dos maxilares, limitam a colocação de implantes nessas regiões. Além disso, devido à ausência dentária, frequentemente, se observa a atrofia dos rebordos maxilares e mandibulares, o que limita o tecido ósseo disponível para a reabilitação dos pacientes com próteses sobreimplantes osseointegráveis. Algumas soluções vêm sendo realizadas a fim de possibilitar a reabilitação com implantes odontológicos em situações adversas, como a utilização de implantes curtos (até 10 mm) e/ou implantes de menor diâmetro (2,8; 3,3 e 3,5 mm). O objetivo deste estudo foi revisar a literatura sobre a utilização de implantes odontológicos curtos, trazendo para o clínico uma visão atual sobre o tema. Com base na literatura atual, conclui-se que os implantes odontológicos curtos apresentam taxa de sucesso clínico semelhante àquela dos implantes convencionais, sendo uma alternativa viável para os procedimentos reabilitadores em situações limítrofes.

Neurofibroma plexiforme da cavidade oral: relato de caso / Plexiform neurofibroma in oral cavity: case report

Os neurofibromas são neoplasmas benignas, originadas de uma mistura de tipos celulares, incluindo as células de schwann e os fibroblastos perineurais. Aparecem como lesões isoladas ou como parte da doença cutânea de von recklinghausen (neurofibromatose). O tratamento de escolha para os neurofibromas consiste na remoção cirúrgica da lesão. O objetivo deste é relatar um caso clínico de neurofibroma plexiforme em cavidade oral

Líquen plano oral: relato de caso / Oral Lichen planus: case report

Introdução: O líquen plano oral é uma doença crônica, que acomete a mucosa bucal. Esse termo refere-se à semelhança das lesões com os liquens, plantas primitivas compostas por algas simbióticas e fungos. Esta doença apresenta natureza etiológica multifatorial e evidências recentes indicam como um distúrbio imunologicamente mediado. Objetivo: Apresentar um caso clínico de líquen plano nas regiões de mucosa jugal e borda lateral de língua, assim como uma revisão de literatura, baseada em periódicos e publicações indexadas (nacionais e internacionais) e internet, enfocando os principais aspectos desta entidade: etiologia, características clínicas e histológicas, bem como seu tratamento. Considerações finais: No caso clínico relatado, o aspecto psicossomático parece ter sido o principal fator desencadeador das lesões bucais. A presença da lesão bucal antecede às cutâneas, evidencia o importante papel dos cirurgiões-dentistas no que diz respeito ao diagnóstico precoce de doenças que afetam toda a integridade do organismo humano