Diagnóstico y tratamiento conservador de quiste dentígero: seguimiento a 3 años / Diagnóstico e tratamento conservador em cisto dentígero: acompanhamento de 3 anos / Diagnosis and conservative treatment of dentigerous cyst: 3-year follow-up

Resumen El quiste dentígero es el quiste de desarrollo odontogénico más común. Aunque puede afectar cualquier diente incluido, los molares y caninos son los más afectados, seguidos por los premolares e incisivos. Este trabajo tiene como objetivo relatar el caso de una paciente de 11 años de edad quien refería ausencia del segundo premolar inferior derecho (45) en el arco dental. De esa manera, se hizo una revisión de literatura abordando el diagnóstico y tratamiento de esta condición. Luego del el exámen clínico y radiográfico se pudo observar una imagen compatible con un de quiste dentígero, cuyo diagnóstico fue confirmado por el examen histopatológico y tomografía computarizada de haz cónico (cone beam). Fue realizado un procedimiento quirúrgico conservador de descompresión utilizando el resultado de la tomografía como guía quirúrgica. Después de 4 meses de seguimiento clínico y radiográfico, se realizó la enucleación de la lesión por curetaje. Se hizo seguimiento de la paciente durante 3 años hasta la erupción completa del diente 45 y su alineación en el arco. No se observaron lesiones y el tratamiento ortodóntico fue eficaz. La técnica de descompresión quirúrgica fue segura, evitó daños de otras estructuras importantes y proporcionó una rápida recuperación de la paciente.

Resumo O cisto dentígero é o cisto de desenvolvimento odontogênico mais comum. Pode envolver qualquer dente incluso, embora molares e caninos sejam os mais afetados, seguidos pelos pré-molares e incisivos. Este trabalho tem como objetivo relatar o caso de uma paciente de 11 anos de idade com queixa de ausência do segundo pré-molar inferior direito (45) no arco dentário. Assim, uma revisão da literatura abordando o diagnóstico e tratamento desta condição é apresentada. No exame clínico e radiográfico pode-se notar imagem sugestiva de cisto dentígero, entretanto o diagnóstico foi confirmado por exame histopatológico e tomografia computadorizada de feixe cônico (cone beam). Optou-se por procedimento cirúrgico conservador de descompressão utilizando o exame cone beam como guia cirúrgico. Depois de 4 meses de acompanhamento clínico e radiográfico foi realizada a enucleação da lesão por curetagem. A paciente foi acompanhada durante 3 anos até a erupção completa do dente 45 e seu alinhamento no arco. Nenhuma lesão foi registrada e o tratamento ortodôntico mostrou-se eficaz. A técnica de descompressão cirúrgica foi segura, evitou danos a estruturas nobres e proporcionou uma rápida recuperação da paciente.

Abstract Dentigerous cyst is the most common developmental odontogenic cyst. It can involve any included tooth, although molars and canines are most frequently affected, followed by premolars and incisors. The aim of this article was to report the case of an 11-year-old female patient complaining of an eruption delay of a mandibular second premolar (45). Therefore, a literature review regarding the diagnosis and treatment of this condition is presented. At clinical and radiographic examination, the image suggested a dentigerous cyst; however, the diagnosis was confirmed by histopathological and cone-beam computed tomography (CBCT) exams. Surgical planning was carried out using a conservative method involving surgical decompression. CBCT was used as a surgical guide. At 4-month clinical and radiographic follow-up, cystic enucleation was performed by curettage. The patient was followed for 3 years until complete eruption and alignment of the teeth occurred. No lesion was recorded, and orthodontic treatment was proven to be successful. The surgical decompression was completely safe, avoiding damage in important structures, and resulted in rapid recovery of the patient.

Analysis of the biofilm formed on the surface of a glass-ionomer cement associated with different concentrations of chlorhexidine diacetate.

PURPOSE: This cross-over in situ experiment evaluated the microbial composition and quantified the total polysaccharides in the biofilm formed on the surface of a high viscosity glass-ionomer cement (GIC) mixed with chlorhexidine diacetate (CHX) in concentrations of 0.5%, 1% and 2%. GIC without CHX was used as control. METHODS: The volunteers (n= 8) tested each material for a 7-day period, by using a palatal acrylic device containing four round specimens, all fabricated with the same material. An increasing order of CHX concentration and a 15-day washout period between each concentration was adopted. The biofilm formed was collected and inoculated in specific culture media and thereafter, the total microorganisms, total streptococci, Streptococcus mutans and Lactobacillus spp were counted. Total polysaccharides were quantified by using a phenol-sulfuric method. Microbiologic data were analyzed by ANOVA for repeated measures and Tukey tests, and the total polysaccharide content by Friedman and Dunn's tests. Significance level was set at 5%. RESULTS: Microorganism counts showed statistically significant differences among groups only for Lactobacillus (P< 0.05), that were significantly higher for group GIC+CHX 2% compared with GIC and GIC+CHX 0.5%. However, the concentration of total polysaccharides in the biofilm was lower for groups containing 1% and 2% of CHX. CLINICAL SIGNIFICANCE: The addition of chlorhexidine in the studied concentrations did not reduce the microorganism counts, but caused reduction of biofilm density.

Expression of the interleukin-10 signaling pathway genes in individuals with Down syndrome and periodontitis.

BACKGROUND: Individuals with Down syndrome (DS) have a higher prevalence and severity of periodontal disease, which cannot be explained by poor oral hygiene alone and is related to changes in the immune response. The aim of this study is to evaluate whether DS was associated with differential modulation of expression of genes associated with proinflammatory and anti-inflammatory responses in periodontal disease. METHODS: A total of 51 individuals were evaluated: 19 individuals with DS and periodontal disease (group 1), 20 euploid individuals with periodontal disease (group 2; positive control), and 12 euploid individuals without periodontal disease (group 3; negative control). Clinical periodontal evaluation and gingival biopsies were performed. Quantitative reverse transcription-polymerase chain reaction was used to determine expression levels of interleukin-10 (IL-10), the receptors IL-10RA and IL-10RB, intracellular adhesion molecule 1 (ICAM-1), interferon-γ-inducible protein 10 (IP-10), and the signaling intermediates Janus kinase 1, signal transducer and activator of transcription 3 (STAT-3), and suppressor of cytokine signaling 3 (SOCS-3). RESULTS: Expression of IL10, SOCS3, IP10, and ICAM1 mRNA in DS patients was significantly lower compared to euploid individuals with periodontal disease, whereas IL-10RB and STAT-3 mRNA levels were higher in individuals with DS. CONCLUSION: Reduced expression of IL-10 coupled with a possible increase of STAT3 activation (increase of STAT3 and reduction of SOCS3 mRNA) indicates an important modulation of the immune response, with attenuation of anti-inflammatory and increase of proinflammatory mediators. This modulation may be related to the increased prevalence and severity of periodontitis in individuals with DS.

Evaluation of 2 endodontic techniques used to treat human primary molars with furcation radiolucency area: A 48-month radiographic study.

OBJECTIVE: To evaluate 2 techniques for the treatment of human primary molars with necrotic pulp and bifurcation bone loss by means of radiographic examination for 48 months. METHOD AND MATERIALS: Fifty-one mandibular primary molars were evaluated in children ranging from 4.5 to 6.5 years of age. The teeth with necrotic pulp and bifurcation bone loss were diagnosed by radiographic examination. The teeth were divided into 2 groups: group 1 (28 teeth) -- pulpotomy technique using formocresol as a temporary dressing between sessions and coronal chamber obturation with zinc oxide-eugenol cement; and group 2 (23 teeth) -- pulpectomy technique with calcium hydroxide paste as a temporary dressing between sessions and root canal obturation with a dense calcium hydroxide paste. Standardized radiographs were taken immediately after the fillings were completed and after 12, 24, 36, and 48 months. The radiographs were digitized and analyzed with software that outlined and measured the bifurcation radiolucency. RESULTS: Bifurcation radiolucency reduced significantly or repaired completely for both treatments in the first 12 months. Minor radiographic reduction of the lesion was observed from 12 to 24 months, and no significant reduction of the remaining radiolucent area was observed from 24 to 48 months after treatment. CONCLUSION: The 2 endodontic techniques evaluated showed similar results. The main effect of treatment on the lesion repair was obtained in the first year after treatment.