A retrospective study of an alternative technique for implant repositioning in the maxillary esthetic region.

BACKGROUND: Implant-bone block segment repositioning may be an option of treatment for patients with vertical alveolar bone atrophy. PURPOSE: To assess implant-bone block movement, gingival outcome and the subjective appreciation of patients after an alternative treatment of an implant-bone block segment repositioning in the maxillary esthetic region. MATERIALS AND METHODS: Patients who underwent implant-bone block segment relocation in areas of vertical alveolar bone atrophy in the anterior esthetic region were assessed. The outcome measures were implant failure, complications after initial loading, vertical bone augmentation, papilla index, width of the keratinized mucosa, and patient satisfaction. RESULTS: Twenty-five implants in nine consecutive patients were included in this study. During the follow-up period, only one implant failed. Vertical bone augmentation ranged from 3.0 to 8.4 mm (mean 4.9 mm). A significant improvement (P < .001) in the papilla index was observed, improving the esthetic outcome. Six patients (66.6%) had more than 2 mm of keratinized mucosa and all of the patients were satisfied with the treatment. CONCLUSIONS: The esthetics and functional gingival outcome of oral rehabilitation in areas with vertical alveolar bone atrophy can be successfully improved with the presented technique, which had a high overall implant survival rate within a short period.

Alternative Distraction Osteogenesis Technique After Implant Placement for Alveolar Ridge Augmentation of the Maxilla.

An alternative technique to reconstruct atrophic alveolar vertical bone after implant placement is presented. The technique consists of distraction osteogenesis or direct surgical repositioning of an implant-and-bone block segment after segmental osteotomies that can be used in esthetic or unesthetic cases. Initially, casts indicating the implant position are obtained and the future ideal prosthetic position is determined to guide the model surgery. After the model surgery, a new provisional prosthesis is fabricated, and an occlusal splint, which is used as a surgical guide and a device for distraction osteogenesis, is custom fabricated. Then, the surgery is performed. For mobilization of the implant-and-bone block segment, 2 vertical osteotomies are performed and then joined by a horizontal osteotomy. The implant-and-bone block segment is moved to the planned position. If a small movement is planned, then the implant-and-bone segment is stabilized; for larger movements, the implant-and-bone segment can be gradually moved to the final position by distraction osteogenesis. This technique has good predictability of the final position of the implant-and-bone segment and relatively fast esthetic rehabilitation. It can be considered for dental implants in regions of vertical bone atrophy.

The relative frequency of odontogenic tumors: A study of 376 cases in a Brazilian population

BACKGROUND: Odontogenic tumors (OTs) are rare lesions, exclusive of the jaws, that are derived from epithelial and/or ectomesenchymal elements of the tooth-forming apparatus. Their biological behavior is heterogeneous, including hamartomatous tissue proliferation, benign nonaggressive and aggressive neoplasms, and malignant tumors with metastatic capacity. The aim of this study was to describe the relative frequency of odontogenic tumors in a Brazilian population. In addition, a review of the literature identified studies on odontogenic tumors that follow the 2005 World Health Organization. MATERIAL AND METHODS: A total of 376 cases of odontogenic tumors from an oral pathology service were reviewed about age, gender, anatomic site and histologic diagnosis. RESULTS: Keratocystic odontogenic tumors (31.6%) were the most common, followed by ameloblastoma (28.5%), and odontoma (22.6%). The mean age was 32.2 years, and more than half the patients (52.1%) were in the second and third decades of life. The male to female ratio was 1:1.37, with a maxilla to mandible ratio of 1:2.08. CONCLUSIONS: The variation in relative frequency of tumors observed among the several series, including the present study, is probably due in part to cultural differences between geographic areas but also to the study design

Surgical Treatment, Oral Rehabilitation, and Orthognathic Surgery After Failure of Pharmacologic Treatment of Central Giant Cell Lesion: A Case Report.

Although pharmacologic treatments for central giant cell lesions have gained much emphasis, these treatment modalities do not always have successful outcomes, and surgical treatment may be necessary. The purpose of the present study was to report a case of aggressive central giant cell lesion initially treated by nonsurgical methods without satisfactory results, necessitating segmental mandibular resection for definitive treatment and oral rehabilitation. A 20-year-old woman was diagnosed with an aggressive central giant cell lesion in the mandible. The patient was first treated with intralesional corticosteroid injections. Subsequently, the lesion increased in size. Therefore, a second pharmacologic treatment was proposed with salmon calcitonin nasal spray, but no signs of a treatment response were noted. Because of the lack of response, surgical excision was performed, and a mandibular reconstruction plate was installed. At 12 months after surgical resection, the patient underwent mandibular reconstruction with bone grafts. After 6 months, 7 dental implants were installed, and fixed prostheses were made. After installation of the prostheses, the patient experienced persistent mandibular laterognathism, and a mandibular orthognathic surgery was performed to correct the laterognathia. The follow-up examination 4 years after orthognathic surgery showed no signs of recurrence and good facial symmetry.

Autotransplantation of Immature Third Molars and Orthodontic Treatment After En Bloc Resection of Conventional Ameloblastoma.

Ameloblastoma treatment can lead to significant bone defects; consequently, oral rehabilitation can be challenging. We present the case of a 14-year-old girl diagnosed with a conventional ameloblastoma in the mandible who was treated using en bloc resection and rehabilitated with autotransplantation of the immature third molars and orthodontic treatment. The lesion was in the region of the lower left canine and premolars, and en bloc resection resulted in a significant alveolar bone defect. Autotransplantation of the lower third molars to the site of the lower left premolars was performed. After 2 years, the upper left third molar was transplanted to the site of the lower left canine. During the orthodontic treatment period, considerable alveolar bone formation was observed in the region of the transplanted teeth, and roots developed. To the best of our knowledge, this is the first reported case of alveolar bone formation induction caused by tooth transplantation after ameloblastoma treatment.

Evaluation of oral diseases in a population of special needs patients / Avaliação das doenças orais em uma população de pacientes com necessidades especiais

Objective: To evaluate the oral health status of a population of patients with special needs cared for in the specialization course of the Brazilian Association of Dentistry, Ceará Branch. Methods: In this cross-sectional, descriptive study the indexes DMFT and CPI were used to evaluate dental caries and periodontal disease, respectively, from August 2009 through March 2010. The need for dental treatment and other soft tissue lesions were also investigated. Results: 88 patients selected by convenience sampling were examined intraorally, and the mean age was 43.8 ± 16. Most of the patients fell within the group of systemic diseases (68.1%), especially cardiovascular diseases (15.9%). The mean DMFT index was 17.54 ± 7.13, and 87.5% of patients presented active dental caries. According to the highest degree of periodontal condition observed in the individual, the dental tartar (index 2) was present in a greater number of patients (50.9%). Regarding the need for dental treatment, 68.1% of patients needed restorative treatment, 43.1% of patients needed surgery (extractions) and 21.5% of patients needed endodontic treatment. There were no soft-tissue abnormalities in most patients (89.7%). Conclusion: The examined patients showed a high prevalence of oral diseases such as dental caries and gingivitis/periodontitis, and therefore a great need for dental treatment. Given the results, it becomes important to stimulate dental care and preventive practices focused on this segment of the population.

Objetivo: Avaliar a condição de saúde bucal de uma população de pacientes com necessidades especiais atendida no curso de especialização da Associação Brasileira de Odontologia, Seção Ceará.Métodos: Nesse estudo de natureza descritiva e transversal utilizou-se os índices CPO-D e IPC para avaliação das doenças cárie e periodontal, respectivamente, entre os meses de Agosto de 2009 e Março de 2010. Necessidades de tratamento dentário e outras lesões em tecidos moles orais também foram investigadas. Resultados: Realizaram-se exames bucais em 88 pacientes selecionados por conveniência, sendo a média de idade correspondente a 43,8 ± 16 anos. A maioria se enquadrava no grupo de doenças sistêmicas (68,1%), destacando-se as diseases cardiovasculares (15,9%). O índice CPO-D médio foi 17,54 ± 7,13, com 87,5% dos pacientes apresentando cárie ativa. Segundo o maior grau de condição periodontal observado no indivíduo, o cálculo dental (índice 2) foi o que esteve presente em um maior número de pacientes (50,9%). Quanto às necessidades de tratamento dental, 68,1% deles necessitaram de tratamento restaurador, 43,1% de tratamento cirúrgico (exodontias) e 21,5% de tratamento endodôntico. Não foram encontradas anormalidades em tecido mole na maioria dos pacientes (89,7%). Conclusão: Os pacientes examinados possuíam alta prevalência de doenças orais, como cárie e gengivite/periodontite e, conseqüentemente, grande necessidade de tratamento odontológico. Diante dos resultados, torna-se importante motivar a atenção odontológica e as práticas preventivas voltadas para essa parcela da população.

Central giant cell lesion of the jaws: study of CCND1 gene amplification and p16INK4a protein levels.

Central giant cell lesions (CGCLs) are uncommon benign jaw lesions with uncertain etiology and a variable clinical behavior. In neoplasms, alterations in molecules involved in the G1/S checkpoint are frequently found. Loss of p16(INK4a) expression or overexpression of cyclin D1 may stimulate cell proliferation. The purpose of this study was to analyze CCND1 gene amplification and the expression of p16(INK4a) in CGCLs. Structural analysis of the CCND1 was performed using chromogenic in situ hybridization. Immmunohistochemistry was used to identify p16(INK4a) protein levels. Statistical analysis correlated the two biomarkers with clinical behavior and between each other. Twenty-four lesions were included, being 11 aggressive and 13 non-aggressive. Moderate/high-level CCND1 amplification was found in 12 lesions. Also, immunoreactivity for p16(INK4a) was present in 12 cases, mainly in mononuclear cells. There was a significantly higher level of p16(INK4a) expression in mononuclear cells of non-aggressive lesions and lesions with moderate/high-level CCND1 amplification in mononuclear cells. It could be speculated that some CGCLs may develop as a true benign neoplasm. The higher expression of p16(INK4a) in non-aggressive lesions and in cases with moderate/high-level CCND1 amplification may show that these molecules have a role in CGCLs.

Intralesional corticosteroid injections in the treatment of central giant cell lesions of the jaws: A meta-analytic study

Objective: The aim of this study was to evaluate the response of treatment of central giant cell lesion to intralesional corticosteroid injections. Study Design: Review of articles indexed in PubMed on the topic between the years 1988 and 2011, and development of a descriptive meta-analysis of the results. Results: Sample of 41 patients primarily treated with intralesional corticosteroid injections was obtained, with a male female ratio of 1:0.95, being 23 aggressive and 18 non-aggressive central giant cell lesions. Triamcinolone acetonide and triamcinolone hexacetonide were the drugs used, and 78.0% cases were considered as good result, 14.6% were considered as moderate response and 7.3% were considered as negative result to treatment. Considering the aggressiveness, 88.9% of non-aggressive lesions presented a good response to treatment, in aggressive (..) (AU)

Intralesional corticosteroid injections in the treatment of central giant cell lesions of the jaws: a meta-analytic study.

OBJECTIVE: The aim of this study was to evaluate the response of treatment of central giant cell lesion to intralesional corticosteroid injections. STUDY DESIGN: Review of articles indexed in PubMed on the topic between the years 1988 and 2011, and development of a descriptive meta-analysis of the results. RESULTS: Sample of 41 patients primarily treated with intralesional corticosteroid injections was obtained, with a male female ratio of 1:0.95, being 23 aggressive and 18 non-aggressive central giant cell lesions. Triamcinolone acetonide and triamcinolone hexacetonide were the drugs used, and 78.0% cases were considered as good result, 14.6% were considered as moderate response and 7.3% were considered as negative result to treatment. Considering the aggressiveness, 88.9% of non-aggressive lesions presented a good response to treatment, in aggressive central giant cell lesions, 69.6% presented a good response to intralesional corticosteroid injections. CONCLUSION: In view of the results analyzed, intralesional corticosteroid injections could be considered as first treatment option for central giant cell lesion.

Tongue lesions.

BACKGROUND: Some authors have shown that tongue lesions represent an important segment of oral mucosal lesions group, with prevalence varying among epidemiologic studies from different countries. OBJECTIVES: The aim of this study was to describe the prevalence of tongue lesions in a Brazilian population. METHODS: A collaborative study was conducted using data from 5 anatomic pathology services in Brazil. After data collection, these tongue lesions were separated in 4 groups: G1/malignant tumors, G2/benign tumors, G3/reactive lesions, and G4/other lesions. RESULTS: Analysis of 6231 specimens for which oral biopsy was performed showed 760 cases (12.2%) diagnosed in the tongue. From this total, 306 cases (40.3%) occurred in females, and 454 (59.7%) occurred in males. Ages ranged from 3 to 93 years, with a global average of 45.3 years. The largest numbers of cases were represented by reactive lesions (44.6%), followed by benign tumors (27.9%), malignant tumors (18.6%), and other lesions (8.9%). CONCLUSIONS: Tongue diseases were more common in male patients, and most of them were reactive lesions or benign neoplasms, but 18.6% were malignant neoplasms. The occurrence of malignant neoplasm increased notably with age.

Cyclooxygenase-2 expression in central giant cell lesion of the jaws: an immunohistochemical study.

Central Giant Cell Lesion (CGCL) is an uncommon benign jaw lesion, with uncertain etiology, and a variable clinical behavior. Studies of molecular markers of CGCL, may help understanding better the nature and behavior of this lesion, and eventually may represent a definitive target to pharmacological approach in the treatment of CGCL. Chronic inflammation has been found to mediate a wide variety of diseases including neoplasms. Among the gene products involved in the induction of the inflammatory process, Cyclooxygenase 2 (COX-2) has been shown to have a close relationship with tumorigenesis, however COX-2 expression has never been evaluated in CGCL. The aim of the study was to investigate the expression of COX-2 in CGCL. Immunohistochemical assessment for COX-2 expression was performed in 18 patients previously diagnosed with CGCL. Multinucleated giant cells (MGC) and mononucleated stromal cells (MSC) were used in the slide analysis. Among the patients studied, 10 were male and 8 were female, with a median age of 15.4 years. Lesions in the mandible were observed in 11 cases and 7 were found in the maxilla. There were 9 aggressive and 9 non-aggressive CGCLs. COX-2 immunopositivity was present in only 3 cases stained in both MGC and MSC. All 3 cases presented with ulcerations in the mucosa lesion, suggesting that the COX-2 expression is due to the presence of inflammation. This study does not support the involvement of COX-2 in the etiophatogenesis of CGCL.

Lip lesions in a Brazilian population.

BACKGROUND: The lips represent one of the most important parts of the facial complex because of a large number and variety of injuries that may be related to this anatomic site such as inflammatory processes and benign and malignant tumors. The aim of this study was to describe the pathologic features of the lip lesions seen in a Brazilian outpatient service. METHODS: Data from 6231 samples of oral biopsies were retrieved from the files of 5 anatomic pathology services in Fortaleza, Brazil. After data have been collected, the lesions were separated in 3 groups: G1 (nonmalignant dysplastic lesions/malignant tumors), G2 (benign neoplasms), and G3 (reactive/inflammatory lesions). RESULTS: Analysis of the specimens for which an oral biopsy was performed yielded 1034 cases (16.6%) diagnosed on lip during the study period. From this total, 514 cases were in females and 520 were in males. Ages ranged from 2 to 96 years, with a global average of 40.1 years. The peak incidence of lip lesions in this study occurred in the fifth decade of life. The most common lesion in each group was squamous cell carcinoma (G1), hemangioma (G2), and mucocele (G3). Lower lip was the most affected region (65.9%). CONCLUSIONS: The largest number of cases represented nonmalignant conditions, which occurred mostly in the lower lip. In addition, malignancies increased significantly with the increase in age. Further studies are necessary for a better worldwide epidemiologic understanding about lip diseases.

Odontogenic tumors: a 5-year retrospective study in a Brazilian population and analysis of 3406 cases reported in the literature.

OBJECTIVE: The objective of this study was to analyze the frequency and distribution of odontogenic tumors in Fortaleza, Brazil, and compare the findings with those reported in the literature. STUDY DESIGN: A total of 6231 oral lesions retrieved from 5 anatomic pathology services in Fortaleza, Brazil, over a 5-year period, were reviewed. In addition, the literature was searched for studies on odontogenic tumors (OTs) according to the 2005 WHO classification. RESULTS: Within the total 6231 oral lesions, 185 (2.97%) were OTs, all benign. OTs presented a female predilection, with a male:female ratio of 0.62:1.00. These neoplasms occurred over a wide range of ages (1 to 78 years), with a mean of 30.5 years. Ameloblastomas, keratocystic odontogenic tumors, and odontomas were the most frequent OT types. CONCLUSIONS: OTs are rare neoplasms and appear to show geographic variations. In Fortaleza, Brazil, they are more common in female patients, with ameloblastoma followed by keratocystic odontogenic tumors as the most frequent OTs.

Oral lipomas in a Brazilian population: a 10-year study and analysis of 450 cases reported in the literature.

OBJECTIVES: Lipomas are common benign mesenchymal neoplasms that rarely occur in the oral cavity and correspond to less than 4.4% of all benign oral soft tissue tumors. This study describes the clinical, radiological and histological features of cases of oral lipomas seen over a period of 10 years and compared the findings with those reported in the literature. STUDY DESIGN: All cases of oral lipomas seen between 1999 and 2009 were retrieved from the archives of the Stomatology Division of the Federal University of Ceará, Brazil. Age, gender, tumor location, clinical findings, duration, histological subtypes, and treatment outcome were recorded. In addition, the English-language literature was searched for studies published between 1966 and 2009. RESULTS: Ten patients (6 women and 4 men) were enrolled in this study. The mean age was 53.4 years (range: 21- 73 years). The specific sites involved were the oral mucosa (n=5), vestibule (n=3), gingiva (n=1), and retromolar region (n=1). The mean size of the tumors was 1.94 cm (range 1.0 to 3.0 cm). Radiographically, only one case appeared as a radiolucent area on occlusal film. Microscopically, 4 cases were classified as simple lipoma, 4 as fibrolipoma, 1 as myxoid lipoma, and 1 as angiolipoma. The duration of the tumors ranged from 2 to 84 months, with a mean duration of 30.4 months. All cases were treated by simple surgical excision and there was no recurrence after a mean post-treatment period of 34.5 months. The findings were compared with 450 cases of oral lipomas reported in the literature. CONCLUSIONS: Lipomas continue to be an uncommon neoplasm of the oral cavity. Radiography is a valuable tool due to the possible occurrence of bone involvement. Surgical excision is the treatment of choice and recurrence is not expected.

Multiple brown tumours of tertiary hyperparathyroidism in a renaltransplant recipient: A case report

Tertiary Hyperparathyroidism (HPT) is an uncommon condition that affects patients with secondary HPT aftera successful kidney transplant. Bone alterations are the main consequences of this endocrine condition, includingthe development of an osteolytic lesion called brown tumour. This paper reports an unusual case of multiplebrown tumours located in the maxilla and mandible in a 58-year-old renal transplant recipient, with tertiary HPT.Incisional biopsies were performed and, in both samples, the histopathological diagnoses were giant cell lesions.Due to these diagnoses, the medical history of chronic renal failure, and high levels of serum calcium and PTH,lesions were diagnosed as multiple brown tumours of tertiary HPT. The lesions showed regression within the twomonths following a total parathyroidectomy. Minimal local interventions were established to make an early diagnosisand to treat these lesions. The diagnosis of primary oral lesions was very important in order to demonstratethe relevance of interdisciplinary activity and the inclusion of dentists as part of organ transplant units (AU)

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Multiple brown tumours of tertiary hyperparathyroidism in a renal transplant recipient: a case report.

Tertiary Hyperparathyroidism (HPT) is an uncommon condition that affects patients with secondary HPT after a successful kidney transplant. Bone alterations are the main consequences of this endocrine condition, including the development of an osteolytic lesion called brown tumour. This paper reports an unusual case of multiple brown tumours located in the maxilla and mandible in a 58-year-old renal transplant recipient, with tertiary HPT. Incisional biopsies were performed and, in both samples, the histopathological diagnoses were giant cell lesions. Due to these diagnoses, the medical history of chronic renal failure, and high levels of serum calcium and PTH, lesions were diagnosed as multiple brown tumours of tertiary HPT. The lesions showed regression within the two months following a total parathyroidectomy. Minimal local interventions were established to make an early diagnosis and to treat these lesions. The diagnosis of primary oral lesions was very important in order to demonstrate the relevance of interdisciplinary activity and the inclusion of dentists as part of organ transplant units.

Management of erythema multiforme associated with recurrent herpes infection: a case report.

Erythema multiforme is an acute mucocutaneous disorder, characterized by varying degrees of blistering and ulceration. We report a case of recurrent herpes-associated erythema multiforme managed with prophylactic acyclovir. An 11-year-old boy had lesions in the oral cavity and lips, which had been diagnosed as erythema multiforme minor. Four months later, the patient had desquamative gingivitis with erythematous lesions and necrotic areas in the skin. This episode was not related to drug intake, which suggests that the erythema multiforme was a result of herpetic infection. This hypothesis was supported by positive serology for herpes simplex virus. Five months later, the patient returned with new oral, skin and penis mucosal lesions. The diagnosis was confirmed as herpes simplex virus-associated erythema multiforme major. The episode was treated with acyclovir, and acyclovir was used prophylactically for 7 months to control the disease.

Oral granulocytic sarcoma: a case report.

UNLABELLED: Granulocytic sarcoma (GS) is a localized infiltrate of immature granulocytes in an extramedullary site. This lesion is most frequently associated with leukemia, but can occur associated with other myeloproliferative disorders. GS can affect virtually any part of the body, but oral lesions are rare, with only 37 cases described. CASE DESCRIPTION: We present a case of GS in a 23-year-old female, with a prior history of acute myeloid leukemia, presenting with a solitary mandibular swelling in the region of the erupting lower left 3rd molar. After biopsy, conventional immunohistochemical stains were positive for CD45 (hematological marker) and myeloid markers, such as myeloperoxidase, and CD68, demonstrating a myeloid lineage with monocytic cell differentiation, suggesting the diagnosis of GS associated to AML-M5. CLINICAL IMPLICATION: Although GS is a rare tumor in the oral cavity, and its diagnosis is usually difficult, the clinician must know of its existence in order to make a differential diagnosis.