Clinicopathologic analysis of oral dermoid and epidermoid cysts: a Brazilian multicenter study.

Dermoid cysts (DCs) and epidermoid cysts (ECs) are uncommon developmental cysts affecting the oral cavity. This study aims to evaluate patients with oral DCs and ECs and their demographic and clinicopathologic features. A retrospective descriptive cross-sectional study was performed. A total of 105,077 biopsy records of oral and maxillofacial lesions from seven Brazilian oral pathology centers were analyzed. All cases diagnosed as oral DCs and ECs were reviewed, and clinical, demographic, and histopathological data were collected. The series comprised 32 DCs (31.4%) and 70 ECs (68.6%). Most of the DCs occurred on the floor of the mouth (n = 14; 45.2%) of women (n = 17; 53.1%) with a mean age of 34.6 ± 21.6 years. All DCs were lined partially or entirely by stratified squamous epithelium (100%). Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were observed in the fibrous capsule . Most of the ECs affected the labial mucosa (n = 20; 31.7%) of men (n = 39; 56.5%) with a mean age of 48.0±19.8 years. Microscopically, most ECs (n = 68; 97.1%) were lined entirely by stratified squamous epithelium. Two cysts (2.9%) showed areas of respiratory metaplasia. Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were also observed in the fibrous capsule. Conservative surgical excision was the treatment of choice in all cases. Oral DCs and ECs are uncommon and often clinically misdiagnosed lesions. Clinicians should consider DCs and ECs in the differential diagnosis of soft tissue lesions in the oral cavity, mainly located on the floor of the mouth and labial mucosa.

Salivary gland tumors: A 13-year clinicopathologic retrospective study in a Brazilian northeast population.

Background: The present study aimed to evaluate the clinicopathologic features of salivary gland tumors (SGTs) in a Brazillian northeast population. Material and Methods: A retrospective descriptive cross-sectional study was performed (1995-2009). All cases of SGTs diagnosed in a private surgical pathology service in Brazil were reviewed, and clinicopathological data were collected. Results: A total of 23.258 histopathological records of biopsies were analyzed, and 174 cases were diagnosed as SGTs (0.7%). Of these, 117 (67.2%) were classified as benign, and 57 (32.8%) were malignant. The series comprised 89 females (51.1%) and 85 males (48.9%), with a mean age of 50.2 years (range: 3-96 years) and a roughly equal female-to-male ratio (1:1). Most tumors occurred in the parotid gland (n = 82, 47.1%), followed by the palate (n = 45, 25.9%), submandibular gland (n = 15, 8.6%). Pleomorphic adenoma (n = 83; 70.9%) and mucoepidermoid carcinoma (n = 19, 33.3%) were the most frequent benign and malignant tumors, respectively. After reevaluation of morphology and immunohistochemical analysis, seven tumors (4.0%) were reclassified following the current WHO Classification of the Head and Neck Tumors. Conclusions: The general features of SGT from the studied Brazilian population were similar to previously published reports in other countries. However, SGTs do not show any sex predilection. Although careful morphological analysis is the key to the correct diagnosis of these tumors, immunohistochemical analysis is essential to establish an accurate diagnosis in the face of challenging cases. Key words:Salivary gland tumors, epidemiology, head and neck pathology.

Immunoexpression of CXCL12 and CXCR4 in Radicular Cysts, Dentigerous Cysts, and Odontogenic Keratocysts.

The aim of this study was to evaluate the immunoexpression of chemokine CXCL12 and its receptor CXCR4 in radicular cysts (RCs), dentigerous cysts (DCs), and odontogenic keratocysts (OKCs), and to correlate the findings with morphologic parameters of RCs (inflammatory infiltrate and cystic epithelium). Twenty RCs, 20 DCs, and 20 OKCs were submitted to immunohistochemistry. The percentages of cytoplasmic (CXCL12 and CXCR4) and nuclear (CXCR4) staining in epithelial and fibrous capsule cells were determined. RCs and DCs exhibited higher epithelial expression of CXCL12 than OKCs ( P <0.05). The expression of CXCL12 in the fibrous capsule was higher in DCs than in RCs and OKCs ( P <0.05). Higher cytoplasmic expression of CXCR4 was observed in the epithelial lining and fibrous capsule of RCs and DCs compared with OKCs ( P <0.05). In the fibrous capsule, DCs exhibited higher nuclear expression of CXCR4 than OKCs ( P <0.05). No significant differences in the immunoexpression of CXCL12 or CXCR4 were observed according to the morphologic parameters of RCs ( P >0.05). Strong positive correlations were found between cytoplasmic and nuclear expression of CXCR4 in the epithelial lining of RCs and DCs and in the fibrous capsule of all groups ( P <0.05). The results suggest the participation of CXCL12 and CXCR4 in the pathogenesis of RCs, DCs, and OKCs. These proteins may be particularly relevant for the development of odontogenic cysts with less aggressive biological behavior, irrespective of their nature (inflammatory or developmental). In RCs, the expression of CXCL12 and CXCR4 may not be related to the intensity of the inflammatory infiltrate or the status of cystic epithelium.

Clinicopathologic analysis of oral dermoid and epidermoid cysts: a Brazilian multicenter study

Abstract Dermoid cysts (DCs) and epidermoid cysts (ECs) are uncommon developmental cysts affecting the oral cavity. This study aims to evaluate patients with oral DCs and ECs and their demographic and clinicopathologic features. A retrospective descriptive cross-sectional study was performed. A total of 105,077 biopsy records of oral and maxillofacial lesions from seven Brazilian oral pathology centers were analyzed. All cases diagnosed as oral DCs and ECs were reviewed, and clinical, demographic, and histopathological data were collected. The series comprised 32 DCs (31.4%) and 70 ECs (68.6%). Most of the DCs occurred on the floor of the mouth (n = 14; 45.2%) of women (n = 17; 53.1%) with a mean age of 34.6 ± 21.6 years. All DCs were lined partially or entirely by stratified squamous epithelium (100%). Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were observed in the fibrous capsule . Most of the ECs affected the labial mucosa (n = 20; 31.7%) of men (n = 39; 56.5%) with a mean age of 48.0±19.8 years. Microscopically, most ECs (n = 68; 97.1%) were lined entirely by stratified squamous epithelium. Two cysts (2.9%) showed areas of respiratory metaplasia. Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were also observed in the fibrous capsule. Conservative surgical excision was the treatment of choice in all cases. Oral DCs and ECs are uncommon and often clinically misdiagnosed lesions. Clinicians should consider DCs and ECs in the differential diagnosis of soft tissue lesions in the oral cavity, mainly located on the floor of the mouth and labial mucosa.

Immunoexpression of CXCL12 and CXCR4 in sporadic and Gorlin-Goltz syndrome-related odontogenic keratocysts.

Background: Differences in the pathogenesis and biological behavior of sporadic and Gorlin-Goltz syndrome-related odontogenic keratocysts (OKCs) have been reported, but the underlying mechanisms are not fully elucidated. Chemokine CXCL12 and its main receptor CXCR4 regulate important events in the pathogenesis of several lesions. Material and Methods: This study evaluated the immunoexpression of CXCL12 and CXCR4 in sporadic and syndromic OKCs. Twenty-two sporadic OKCs and 22 syndromic OKCs were subjected to immunohistochemistry. The percentages of cytoplasmic (CXCL12 and CXCR4) and nuclear (CXCR4) staining in epithelial and fibrous capsule cells were determined. The results were analyzed statistically using the nonparametric Mann-Whitney test and Spearman correlation test (p<0.05). Results: Higher cytoplasmic expression of CXCL12 was observed in the epithelial lining and fibrous capsule of sporadic OKCs compared to syndromic OKCs (p<0.001). No statistically significant differences in the cytoplasmic expression of CXCR4 were observed between syndromic OKCs and sporadic OKCs (p>0.05). Compared to syndromic OKCs, sporadic OKCs exhibited higher nuclear expression of CXCR4 in the epithelial lining and lower immunoexpression in the fibrous capsule (p<0.05). In the epithelial lining of syndromic OKCs, positive correlation was observed between cytoplasmic and nuclear expressions of CXCR4 (p=0.003). In the fibrous capsule of syndromic OKCs and sporadic OKCs, cytoplasmic and nuclear expressions of CXCR4 were positively correlated (p<0.001). Conclusions: The results suggest a potential participation of CXCL12 and CXCR4 in the development of OKCs. The heterogeneous expression of these proteins in syndromic and sporadic OKCs may reflect differences in their pathogenesis and biological behavior. Key words:Odontogenic keratocyst, CXCL12, CXCR4, Immunohistochemistry.

Differential diagnoses of solitary and multiple pigmented lesions of the oral mucosa: Evaluation of 905 specimens submitted to histopathological examination.

BACKGROUND: The aim was to analyze the frequency, clinical and demographic features of solitary and multiple/diffuse oral pigmented lesions submitted to histopathological examination, and to summarize the features that guide the clinical differential diagnosis. METHODS: Clinical and demographic data were retrieved from biopsy records and descriptive statistics were performed. RESULTS: Nine hundred and five (0.51%) oral pigmented lesions were retrieved among 177 356 specimens, being 95.9% solitary and 4.1% multiple/diffuse lesions. Regardless the overlapping clinical presentation, age, site, association with amalgam restoration, and a nodular appearance may help in the clinical differential diagnosis of solitary oral pigmentations. Patient's habits, site, and systemic signs and symptoms are helpful in the clinical differential diagnosis of multiple/diffuse lesions. CONCLUSIONS: Oral pigmented lesions are a rare diagnosis in oral pathology and solitary lesions are more commonly submitted to biopsy. Some key features help in the differential diagnosis, though biopsy can be warranted in doubtful cases.

Laminados cerâmicos: uma análise discursiva com ênfase na técnica reabilitadora e suas correlações clínicas / Ceramic laminates: a discursive analysis with emphasis in the rehabilitation technique and its clinical correlations

Introdução: com as melhorias em sistemas cerâmicos e cimentos resinosos, é possível criar restaurações com propriedades ópticas semelhantes aos dentes naturais. Um exemplo deste avanço foi o aperfeiçoamento do uso dos laminados cerâmicos, que são uma alternativa reabilitadora mais conservadora do que as restaurações com coroa total e podem ser obtidos resultados de alta qualidade Objetivo: este trabalho objetiva realizar uma revisão de literatura sobre os laminados cerâmicos fazendo uma análise discursiva com ênfase na técnica reabilitadora e suas correlações clínicas. Materiais e Métodos: este estudo caracterizou-se por uma busca bibliográfica nas bases de dados eletrônicos: PubMED/Medline, Lilacs, e Science Direct, limitando-se a busca ao período de 2009 a 2018. Foram consultados 150 trabalhos e destes 32 foram selecionados após uma criteriosa filtragem. Como critérios de inclusão, foram adotados os artigos escritos em inglês, espanhol e português, aqueles que se enquadravam no enfoque do trabalho e os mais relevantes em termos de delineamento das informações desejadas. Resultados: as reabilitações estéticas com laminados cerâmicos devem ser planejadas corretamente, visto que o passo a passo clínico interfere na longevidade do tratamento. Sendo assim, é de extrema importância que o cirurgião-dentista tenha conhecimento da correta indicação das cerâmicas, preparo dentário, moldagem e cimentação para que seja alcançada uma reabilitação estética, funcional e durável. Conclusão: os laminados cerâmicos podem ser uma alternativa conservadora para restabelecer a forma e a cor dos dentes anteriores. Todavia, depende de um protocolo meticuloso que deve ser seguido à risca.

Introduction: With improvements in ceramic systems and resin cements, it is possible to create restorations with optical properties similar to natural teeth. An example of this advancement has been the improvement in the use of ceramic laminates, which are a more conservative rehabilitation alternative than full crown restorations and high quality results can be obtained. Objective: This work aims to perform a literature review on ceramic laminates, making a discursive analysis with emphasis on the rehabilitation technique and its clinical correlations. Materials and Methods: This study was characterized by a bibliographic search in the electronic databases: PubMED / Medline, Lilacs, and Science Direct, limiting the search to the period from 2009 to 2018. 150 papers were consulted and 32 of these were selected after careful filtering. As inclusion criteria, articles written in English, Spanish and Portuguese were adopted, those that fit the work focus and the most relevant in terms of the design of the desired information. Results: Aesthetic rehabilitations with ceramic laminates should be planned correctly, since clinical step-by-step interferes with the longevity of the treatment. Therefore, it is extremely important that the dental surgeon be aware of the correct indication of the ceramics, dental preparation, molding and cementation in order to achieve aesthetic, functional and durable rehabilitation. Conclusion: Therefore, ceramic laminates may be a conservative alternative for restoring the shape and color of the anterior teeth. However, it depends on a meticulous protocol that must be followed to the letter.

Intermediários para próteses parafusadas: pilares que utilizam dois parafusos / Interface intermediaries for screws: pillars using two screws

Introdução: a implantodontia se firmou como uma realidade graças à longevidade dos tratamentos e aos resultados funcionais obtidos. Entretanto, determinadas situações clínicas dificultavam sua aplicação, devido às limitações de certos componentes, às vezes estéticas, às vezes mecânicas. Objetivo: avaliar, por meio de uma revisão de literatura, as indicações, contraindicações, vantagens, desvantagens, e a aplicabilidade entre os principais tipos de pilares intermediários parafusados que utilizam dois parafusos, em prótese fixa unitária e parcial sobre implante. Métodos: foi realizada uma revisão de literatura sistematizada nas bases de dados eletrônicas, Bireme, Pubmed, Medline, e no portal capes. Conclusão: a seleção de componentes protéticos é um pré-requisito para o sucesso da reabilitação oral, e está intimamente ligada à modalidade protética a ser usada nas restaurações sobre implantes orais. Sendo assim, para uma seleção adequada, é importante conhecer não somente as diferentes opções de componentes disponíveis no mercado, como também estar familiarizado com o quadro clínico do paciente, para que, assim, se obtenha resultados favoráveis.

Introduction: implantology has established itself as a reality thanks to the longevity of the treatments and the functional results obtained. However, certain clinical situations made it difficult to apply due to the limitations of certain components, sometimes aesthetic, sometimes mechanical. Objective: to evaluate the indications, contraindications, advantages, disadvantages and applicability between the main types of intermediate screw bolts using two screws, in fixed and partial implants on implants. Methods: a systematized literature review was performed in the electronic databases, Bireme, Pubmed, Medline, and in the capes portal. Conclusion: the selection of prosthetic components is a prerequisite for the success of oral rehabilitation, and is closely related to the prosthetic modality to be used in oral implant restorations. Therefore, for an adequate selection, it is important to know not only the different options of components available in the market, but also to be familiar with the clinical picture of the patient, in order to obtain favorable results.

Sistema CAD-CAM: a tecnologia na confecção de próteses / CAD-CAM System: the technology in the manufacture of prostheses

Introdução: através da introdução na odontologia do sistema CAD- -CAM simplificou-se o sistema de moldagem de próteses, que apresenta uma margem de erro por conter variáveis a serem controladas em relação aos materiais e sua manipulação. Objetivo: este artigo aborda o desenvolvimento do sistema CAD-CAM, como também a engenharia, os programas e as diretrizes de seu funcionamento na confecção de próteses dentárias. Materiais e métodos: o estudo caracterizou-se por uma pesquisa científica e bibliográfica nas plataformas indexadas nas bases de dados PubMED/Medline, Lilacs e Scielo, incluindo artigos originais e de revisão. Utilizou-se os seguintes descritores: Sistema CAD-CAM, CAD-CAM tecnologia no desenvolvimento de próteses, CAD-CAM system. Resultados: tecnologia CAD-CAM surgiu para facilitar o planejamento, o designer e a produção de vários projetos. Quando foi introduzida na odontologia trouxe um marco que revolucionou a forma de confeccionar restaurações, incluindo as protéticas. Sendo desenvolvido por várias empresas, está disponível em diferentes sistemas que, no entanto, se resumem no mesmo funcionamento: digitalização, designer e usinagem, no qual se obtém a imagem através de um escaneamento, manipula-se essa imagem em um software e finalmente converte-se essa imagem em um objeto real, como exemplo em: coroas, pontes, facetas, inlays, onlays e laminados. Conclusão: tendo em vista que essa tecnologia trouxe melhoria para a odontologia protética, na estética, resistência e durabilidade da restauração produzida, melhora a qualidade da saúde bucal oferecida para o paciente e facilita o trabalho do dentista.

Introduction: through the introduction of the CAD-CAM system, the prosthesis molding system has been simplified, which has a margin of error because it contains variables to be controlled in relation to materials and their manipulation. Objective: this article addresses the development of the CAD-CAM system, as well as the engineering, programs and guidelines of its operation in the manufacture of dental prostheses. Methods: this study was characterized by a scientific and bibliographic research in the platforms indexed in PubMED / Medline, Lilacs and Scielo databases, including original and review articles. The following descriptors were used: CAD-CAM system, CAD-CAM technology in prosthesis development, CAD-CAM system. Results: CAD-CAM technology has emerged to facilitate planning, design and production of various projects. When introduced to dentistry brought a landmark that revolutionized the way to make restorations, including prosthetics. Being developed by several companies, it is available in different systems which, however, are summarized in the same operation: digitization, designer and machining, in which the image is obtained through a scan, manipulate that image in a software and finally, this image in a real object, such as: crowns, bridges, facets, inlays, onlays and laminates. Conclusion: since this technology has brought improvement to the prosthetic dentistry, in the esthetics, resistance and durability of the restoration produced, improves the quality of oral health offered to the patient and facilities the work of the dentist.

Cerâmicas odontológicas: classificação, propriedades e considerações clínicas / Dental ceramics: classification, properties and clinical considerations

Introdução: torna-se rotineiro o uso de restaurações em cerâmica para restaurações estéticas nas clínicas odontológicas. Sua aplicação clínica consagrou-se por apresentar várias propriedades desejáveis de forma semelhante aos dentes naturais. Objetivo: sintetizar informações de bases científicas que discorram sobre o uso das cerâmicas odontológicas enfatizando as suas propriedades, indicações, classificações e correlações clínicas. Materiais e métodos: para a confecção desta pesquisa, foi realizado um levantamento bibliográfico onde foram consultados 60 trabalhos e destes 20 foram selecionados após uma criteriosa filtragem. Como critérios de inclusão, foram adotados os artigos escritos em inglês, espanhol e português, Recebido em: 24/09/2017 aqueles que se enquadravam no enfoque do trabalho, que estivessem no período de 2011 a 2017 e os mais relevantes em termos de delineamento das informações desejadas. Resultados: as cerâmicas odontológicas, devido ao seu melhoramento clínico, estão cada vez mais sendo requisitadas nos consultórios odontológicos. Isto é possível devido a algumas características, dentre as quais se destacam: semelhança com dente, estabilidade química, coeficiente de expansão térmica linear próxima ao da estrutura dentária, compatibilidade biológica, assim como a maior resistência à compressão e à abrasão. Conclusão: a longevidade do laminado de porcelana depende da seleção cuidadosa de casos, do preparo meticuloso dos dentes, etapas laboratoriais e protocolos adesivos. Assim como, depende de fatores, que vão desde propriedades físicas do próprio material aos procedimentos clínicos. Compreender a influência destes fatores na longevidade da cerâmica pode ser muito complexo, devido às inúmeras variáveis.

Introduction: the use of ceramic for aesthetic restorations in dental clinics becomes routine. Its clinical application are due to the presence of several desirable properties of form similar to the natural teeth. Objective: synthesize information from scientific bases that discuss the use of dental ceramics emphasizing their properties, indications, classifications and clinical correlations. Materials and methods: In order to prepare this research, a bibliographic survey was carried out in which 60 papers were consulted and of these 20 were selected after a careful filtering. As inclusion criteria, articles written in English, Spanish and Portuguese were adopted, those that fit the work focus, which were in the period from 2011 to 2017 and the most relevant ones in terms of the design of the desired information. Results: Dental ceramics, due to their clinical improvement, are increasingly being requested in dental offices. This is possible due to some characteristics, such as tooth resemblance, chemical stability, coefficient of linear thermal expansion close to tooth structure, biological compatibility, as well as greater resistance to compression and abrasion. Conclusion: the longevity of the porcelain laminate depends on the careful selection of cases, the meticulous preparation of the teeth, laboratory steps and adhesive protocols. As well, it depends on factors, ranging from physical properties of the material itself to clinical procedures. Understanding the influence of these factors on ceramic longevity can be very complex due to the innumerable variables.