Does Liquid/Injectable Platelet-Rich Fibrin Help in the Arthrocentesis Treatment of Temporomandibular Joint Disorder Compared to Other Infusion Options? A Systematic Review of Randomized Clinical Trials.

Temporomandibular joint disorders (TMDs) are prevalent musculoskeletal conditions involving pain and dysfunction of jaw mobility and function, which have proven difficult to treat satisfactorily. The present study aimed to assess the effectiveness of a liquid platelet-rich fibrin (i-PRF) infusion during arthrocentesis versus other options using coadjuvant materials to reduce TMD symptoms. A literature search was conducted using PubMed, EMBASE, Web of Science, Scopus, and ClinicalTrials.gov for RCTs published before January 2024, comparing i-PRF to any other TMD treatment. This systematic review was registered on PROSPERO (CRD42023495364). The searches generated several recent RCTs that compared i-PRF injection combined with arthrocentesis (AC) to AC-only or AC with platelet-rich plasma (PRP). The outcomes analyzed included measures of pain (visual analog scale, VAS), maximum mouth opening, joint sounds, and MRI-verified changes in joint structure. Across the RCTs, the addition of i-PRF injection to AC resulted in significant improvements in pain relief, joint function, mouth opening, and structural changes compared to AC-only or with PRP over follow-up periods ranging from 6 to 12 months. Current clinical evidence favors using i-PRF as an adjunct to AC rather than AC-only or AC with PRP for the treatment of TMDs. The improvements in subjective and objective outcome measures are clinically meaningful. Still, additional high-quality RCTs with larger sample sizes and longer follow-ups are required to strengthen the evidence base and better define the role of i-PRF in TMD management guidelines.

Estudo da expressão imuno-histoquímica das proteínas MMP-9, MMP-13, e TIMP-1 em ameloblastomas e tumores odontogênicos ceratocistos / Study of immunohistochemical expression of MMP -9, MMP -13 protein, and TIMP - 1 in ameloblastomas and odontogenic keratocysts tumors

Os ameloblastomas e tumores odontogênicos ceratocísticos (TOC) representam lesões odontogênicas que, apesar de sua natureza benigna, se destacam por um comportamento biológico distinto, caracterizado pelo crescimento localmente agressivo e episódios recidivantes. A reabsorção dos ossos gnáticos provocada pelo crescimento dessas lesões constitui um fator determinante à expansão das mesmas, sendo mediada tanto por células osteoclásticas como pela ação enzimática de diversas metaloproteinases de matriz (MMPs). A expressão de fatores estimuladores e inibidores da reabsorção óssea vem sendo correlacionada com o desenvolvimento destas lesões, merecendo destaque algumas MMPs como as colagenases e as gelatinases e os inibidores teciduais de metaloproteinases (TIMPs), dentre outros. Baseados na premissa de que fatores estimuladores e inibidores de processos osteolíticos podem ser determinantes para o ritmo de crescimento de lesões odontogênicas intraósseas, o objetivo de estudo foi avaliar a imunoexpressão das proteínas MMP-9, -13 e TIMP-1 no epitélio e mesênquima de espécimes de ameloblastomas e TOC. A análise estatística foi realizada através dos testes de Mann-Whitney e Wilcoxon com nível de significância estabelecido em 5%. Através de uma análise quantitativa das células imunomarcadas, foi observada a expressão imuno-histoquímica das MMP-9, -13 e TIMP-1 em 100% dos casos, tanto no epitélio quanto no mesênquima tumoral. Mais de 76% das células epiteliais (escore 3) dos TOC e ameloblastomas apresentaram imunomarcação para MMP-9 (p=0,382) e MMP-13 (p=0,069), sendo estatisticamente significativa para o TIMP-1 (p=0,003) nos ameloblastomas. No mesênquima, observou-se maior escore de imunomarcação da MMP-13 (p=0,031) nos ameloblastomas em relação aos TOC, enquanto para a MMP-9 e TIMP-1 não se observou diferença estatisticamente significativa (p=0,403; p=1,000). O cálculo da razão entre os escores de expressão das proteínas revelou, de uma maneira geral, similaridade entre as lesões, sendo observado predomínio significante de igualdade de expressão do TIMP-1 e da MMP-9 apenas no epitélio dos ameloblastomas. A imunoexpressão marcante das MMP-9, MMP-13 e TIMP-1 no epitélio e mesênquima das lesões estudadas indica que estas proteínas participam na remodelação da MEC necessária à progressão tumoral, no entanto, as diferenças pontuais observadas na expressão de algumas destas proteínas, não são suficientes para sugerir diferenças no comportamento biológico dos ameloblastomas e dos TOCs. (AU)

Ameloblastomas and keratocystic odontogenic tumors (KOT) represent odontogenic lesions that, despite their benign nature, are distinguished by a distinct biological behavior, characterized by locally aggressive growth and recurrent episodes. The gnathic bone resorption caused by the growth of these lesions is a key to the expansion of the same, both being mediated by osteoclastic cells like enzymatic activity of various matrix metalloproteinases (MMPs) factor. The expression of stimulatory factors and inhibitors of bone resorption has been correlated with the development of these lesions, with emphasis to some MMPs such as collagenases and gelatinases and tissue inhibitors of metalloproteinases (TIMPs), among others. Based on the premise that stimulatory and inhibitory factors of osteolytic processes can be decisive for the growth rate of intraosseous odontogenic lesions, this experiment evaluated the immunoreactivity of MMP-9, -13 and TIMP-1 protein in the epithelium and mesenchyme of ameloblastoma and the KOT specimens, by a quantitative analysis of the immunoreactivity cells. Statistical analysis was performed using the MannWhitney and Wilcoxon tests with a significance level set at 5 %. Immunohistochemical expression of MMP-9, -13 and TIMP-1 was observed in 100% of cases both in the epithelium and in mesenchyme. The immunoreactivity in the epithelium of KOT and ameloblastomas revealed a predominance of score 3 for MMP-9 (p=0.382) and MMP-13 (p=0.069) and no statistically significance for TIMP-1, the latter being significantly higher immunoreactivity in ameloblastomas. In the mesenchyme, there was a higher score immunoreactivity of MMP-13 (p=0.031) in ameloblastomas in relation to KOT, whereas for MMP-9 and TIMP-1 no statistically significant difference (p=0.403 was observed, p=1.000). The calculation of the ratio of scores revealed expression of proteins in general, similarity of the lesions, a significant predominance of equal expression of TIMP-1 and MMP-9 was observed only in the epithelium of ameloblastoma. The marked immunostaining of MMP-9 , MMP-13 and TIMP-1 in epithelium and mesenchyme of the lesion indicate that these proteins involved in ECM remodeling required for tumor progression, however, specific differences in the expression of some of these proteins, are not sufficient to suggest differences in the biological behavior of ameloblastomas and KOTs. (AU)

Cisto linfoepitelial oral: relato de quatro casos e revisão de 119 casos apresentados na literatura / Oral lymphoepithelial cyst: report of 4 cases and review of 119 cases reported in the literature

INTRODUÇÃO: O cisto linfoepitelial oral é uma lesão incomum, assintomática e de pequenas dimensões, geralmente descoberto durante exames de rotina da cavidade bucal. OBJETIVO: Relatar quatro casos de cisto linfoepitelial oral, confrontando seus aspectos com aqueles reportados em outros 119 casos publicados na literatura. RELATO DOS CASOS: Três casos em mulheres, com idade entre 16 e 23 anos, e um caso em homem, com 45 anos, caracterizados por nódulos assintomáticos, de pequenas dimensões e coloração variando do branco ao amarelado. Dois casos estavam localizados na superfície ventral da língua, um em assoalho bucal e outro em orofaringe. Histologicamente, as lesões revelaram cavidade cística contendo quantidade variável de células epiteliais descamadas, revestida por epitélio pavimentoso estratificado, predominantemente paraceratinizado, de interface plana com o tecido conjuntivo. A cápsula fibrosa exibiu um denso infiltrado linfocítico, com identificação de centros germinativos em apenas dois casos. CONCLUSÃO: A análise conjunta dos casos apresentados neste trabalho e de outros 119 casos relatados na literatura revela que os cistos linfoepiteliais orais exibem predileção pelo gênero masculino, com ápice de incidência na terceira década de vida. Em geral, essas lesões se apresentam como pequenos nódulos assintomáticos localizados no assoalho bucal. Histologicamente, a maioria dos casos revela epitélio cístico com padrão de maturação paraceratinizado e exibe centros germinativos na cápsula fibrosa.

INTRODUCTION: The oral lymphoepithelial cyst is a rare, asymptomatic lesion with small dimensions, commonly discovered during routine examination of the oral cavity. OBJECTIVE: To report four cases of oral lymphoepithelial cyst and compare their aspects with other 119 cases reported in the literature. CASE REPORT: Three cases in women, age range 16 to 23, and one case in a 45-year-old man, all of them presenting small, asymptomatic, yellowish-white nodules. Two cases were located in the ventral surface of the tongue, one in the buccal floor and one in the oropharynx. Histologically, the lesions showed cystic cavity with variable amount of desquamated epithelial cells, lined with a parakeratinized stratified squamous epithelium and a plane interface with the connective tissue. The fibrous capsule showed a dense lymphocyte infiltrate with germinal centers in only two cases. CONCLUSION: The analysis of the cases herein and the other 119 cases reported in the literature reveals that oral lymphoepithelial cysts present a predilection for males, with peak of incidence in the third decade of life. Characteristically, these lesions consist of small asymptomatic nodules located in the buccal floor. Histologically, most cases show a parakeratinized epithelial lining and germinal centers in the fibrous capsule.

Lipomas of the oral cavity: clinical and histopathologic study of 41 cases in a Brazilian population.

This study evaluated the clinical and histopathologic aspects of 41 cases of oral lipomas diagnosed in a Brazilian population. All records from patients diagnosed with oral lipoma between 1970 and 2008 were reviewed. Histological sections were evaluated by light microscopy. There was a predominance of females (2.4:1), with a peak incidence between the sixth and seventh decade. The buccal mucosa was the most affected site (53.7%), followed by the buccal sulcus (14.6%) and tongue (9.8%). Tumor size ranged from 0.5 to 10 cm and the mean reported duration was 48 months. Histologically, the following variants were identified: lipoma (41.5%), fibrolipoma (34.1%), spindle cell lipoma (9.8%), sialolipoma (9.8%), osteolipoma (2.4%), and chondrolipoma (2.4%). Most tumors were well delimited, irrespective of the variant. Lipomas are rare tumors of the oral cavity. The characterization of new variants, such as sialolipomas, and the identification of histological subtypes in already known variants, such as low-fat and fat-free spindle cell lipomas, highlight the importance for careful microscopic evaluation of these tumors, which might be combined with immunohistochemistry in some cases.