Giant Peripheral Ossifying Fibroma Treated With Piezosurgery and Platelet-Rich Fibrin: A Rare Case Report.

INTRODUCTION: The peripheral ossifying fibroma (POF) is a benign reactive lesion that exclusively arises from gingiva. The lesion may gain considerably large sizes and present peculiar clinical and radiographic features that would then allow it to be called a giant POF; in that case, its otherwise simple surgical extraction could create a challenge. Thus, we elect here, for the very first time, a plausible alternative for treating giant POF: piezosurgery followed by placement of platelet-rich fibrin (PRF). CASE PRESENTATION: A 31-year-old black male presented a large asymptomatic nodule on the lower gingiva; the lesion had caused vestibular displacement of teeth and had been present for 18 years. Following the diagnostic hypothesis of a giant POF, an excisional biopsy was performed under local anesthesia using piezosurgery (microvibration of 36,000 times/sec was used in a bone cortical working mode), which confirmed the diagnosis. The surgical procedure was facilitated with the use of piezosurgery followed by placement of PRF, being the trans- and postoperative periods occurred with no complications. One year after the treatment, the patient shows no signs of disease recurrence and remains under follow-up. CONCLUSIONS: Giant POF is a rare gingival reactive lesion that can reach large dimensions, causing teeth displacement, functional, and esthetic impairments. The lesion can be successfully managed with piezosurgery and PRF, as illustrated herein, avoiding extensive bone loss and damage to the surrounding soft tissues.

Photodynamic inactivation of Paracoccidioides brasiliensis helps the outcome of oral paracoccidiodomycosis.

The antifungal drug therapy often employed to treat paracoccidiodomycosis (PCM), an important neglected fungal systemic infection, leads to offensive adverse effects, besides being very long-lasting. In addition, PCM compromises the oral health of patients by leading to oral lesions that are very painful and disabling. In that way, photodynamic therapy (PDT) arises as a new promising adjuvant treatment for inactivating Paracoccidioides brasiliensis (Pb), the responsible fungus for PCM, and also for helping the patients to deal with such debilitating oral lesions. PDT has been linked to an improved microbial killing, also presenting the advantage of not inducing immediate microbial resistance such as drugs. For the present study, we investigated the generation of reactive oxygen species (ROS) by using the fluorescent probes hydroxyphenyl fluorescein (HPF) and aminophenyl fluorescein (APF) after toluidine blue (TBO-37.5 mg/L)-mediated PDT (660 nm, 40 mW, and 0.04 cm2 spot area) and the action of TBO-PDT upon Pb cultures grown for 7 or 15 days in semisolid Fava Netto's culture medium; we also targeted oral PCM manifestations by reporting the first clinical cases (three patients) to receive topic PDT for such purpose. We were able to show a significant generation of hydroxyl radicals and hypochlorite after TBO-PDT with doses around 90 J/cm2; such ROS generation was particularly useful to attack and inactivate Pb colonies at 7 and 15 days. All three patients reported herein related an immediate relief when it came to pain, mouth opening, and also the ability to chew and swallow. As extracted from our clinical results, which are in fact based on in vitro outcomes, TBO-PDT is a very safe, inexpensive, and promising therapy for the oral manifestations of PCM.

Low-level laser therapy to the mouse femur enhances the fungicidal response of neutrophils against Paracoccidioides brasiliensis.

Neutrophils (PMN) play a central role in host defense against the neglected fungal infection paracoccidioidomycosis (PCM), which is caused by the dimorphic fungus Paracoccidioides brasiliensis (Pb). PCM is of major importance, especially in Latin America, and its treatment relies on the use of antifungal drugs. However, the course of treatment is lengthy, leading to side effects and even development of fungal resistance. The goal of the study was to use low-level laser therapy (LLLT) to stimulate PMN to fight Pb in vivo. Swiss mice with subcutaneous air pouches were inoculated with a virulent strain of Pb or fungal cell wall components (Zymosan), and then received LLLT (780 nm; 50 mW; 12.5 J/cm2; 30 seconds per point, giving a total energy of 0.5 J per point) on alternate days at two points on each hind leg. The aim was to reach the bone marrow in the femur with light. Non-irradiated animals were used as controls. The number and viability of the PMN that migrated to the inoculation site was assessed, as well as their ability to synthesize proteins, produce reactive oxygen species (ROS) and their fungicidal activity. The highly pure PMN populations obtained after 10 days of infection were also subsequently cultured in the presence of Pb for trials of protein production, evaluation of mitochondrial activity, ROS production and quantification of viable fungi growth. PMN from mice that received LLLT were more active metabolically, had higher fungicidal activity against Pb in vivo and also in vitro. The kinetics of neutrophil protein production also correlated with a more activated state. LLLT may be a safe and non-invasive approach to deal with PCM infection.

Photoinduced electron-transfer mechanisms for radical-enhanced photodynamic therapy mediated by water-soluble decacationic C70 and C84O2 Fullerene Derivatives.

Fullerenes are promising candidates for photodynamic therapy (PDT). Thus, C70 and novel C84O2 fullerenes were functionalized with and without an additional deca-tertiary ethyleneamino-chain as an electron source, giving rise to two distinct pairs of photosensitizers, the monoadducts LC-17, LC-19 and the bisadducts LC18 and LC-20 to perform PDT in HeLa cells with UVA, blue, green, white and red light. Shorter wavelengths gave more phototoxicity with LC-20 while LC-19 was better at longer wavelengths; the ratio between killing obtained with LC-19 and LC-20 showed an almost perfect linear correlation (R = 0.975) with wavelength. The incorporation of a deca-tertiary amine chain in the C84O2 fullerene gave more PDT killing when excited with shorter wavelengths or in the presence of low ascorbate concentration through higher generation of hydroxyl radicals. Photoactivated C84O2 fullerenes induced apoptosis of HeLa cancer cells, together with mitochondrial and lysosomal damage demonstrated by acridine orange and rhodamine 123 fluorescent probes. FROM THE CLINICAL EDITOR: Photoactivated C70 and C84O2 fullerenes were demonstrated to induce apoptosis of HeLa cancer cells, together with mitochondrial and lysosomal damage, as a function of wavelength. The study is paving the way to future clinical uses of these agents in photodynamic therapy.

Oral squamous cell carcinoma: an analysis of 1,564 cases showing advances in early detection.

The present study aimed to detect possible differences in the data of oral squamous cell carcinomas (OSCC) cases diagnosed in a Dental School in São Paulo city over the last 40 years. The records of patients diagnosed as having OSCC between the years 1960 and 2008 were retrieved. The whole period was divided into four time periods. A total of 1,564 cases were reviewed. The variables analyzed were: sex, age, race, anatomical site, lesion duration, and lesion size. The chi-square test was used for statistical analysis. Overall, males were more affected than females (3:1), but when comparing the first and last time periods, the ratio decreased significantly (5.8:1 to 2.8:1). A significant increase in the rate of OSCC in patients over 80 years was observed in the last time periods. The gingiva was the most affected site, but the frequency of lower lip involvement increased in the last time period. Regarding lesion size and duration of symptoms at the time of diagnosis, there was a significant difference between the first and last time periods. Smaller lesions were found and the time of lesion development was shorter in the last few years of the study. These findings support the optimistic view that, in recent years, earlier diagnosis has resulted from early oral cancer detection in São Paulo city.