Experience with 808-nm diode laser in the treatment of 47 cases of oral vascular anomalies.

Treatment of oral vascular anomalies (OVA) has focused on minimally invasive techniques rather than radical surgery. We investigated the efficacy and safety of diode laser using the photocoagulation technique in the management of OVA. Forty-seven subjects with OVA were treated with forced dehydration with induced photocoagulation (FDIP) using diode laser (808 nm/4.5 W). This series consisted mostly of male (63.8%) and non-white (63.8%) patients with a mean age of 57.4 years. Varices (91.5%), venous malformations (6.4%), and hemangiomas (2.1%) with a mean size of 7.1 (±4.9) mm were the conditions treated. OVA presented as a nodular lesion (63.8%) involving mainly the lower lip (46.8%). Pulsed laser mode was used as standard and the number of applications varied from one to four sessions, with the majority requiring only one (83%) FDIP session. Kaplan-Meier analysis revealed that complete clinical healing can occur on the 15th day (n=9/29.5%), followed by the 20th (n=6/45.5%), and 30th (n=7/70.5%) days. Postoperative edema was observed in 31 (66%) patients, and recurrence of the lesion occurred in two (4.2%). Based on the data on complete clinical healing, minimal patient discomfort, and satisfactory esthetic results, we can confirm that FDIP by diode laser is a promising candidate for the safe and efficacious treatment of OVA.

Oral conditions of children with microcephaly associated with congenital Zika syndrome: a cross-sectional study.

The aim of the present study was to compare the oral conditions of children with congenital Zika syndrome (CZS)-associated microcephaly, non-CZS-associated microcephaly, and normotypical children, as well as to characterize their sociodemographic aspects and medical history. A paired cross-sectional study was carried out on 14 children with CZS-associated microcephaly and 24 age-matched controls, in Belo Horizonte, in southeastern Brazil. Children's oral conditions were assessed: dental caries experience (dmft/DMFT indices); developmental defects of enamel (DDE) index; dental anomalies; mucosal changes; lip sealing, and malocclusion (overjet, overbite, and/or posterior crossbite alterations). The quality of oral hygiene was analyzed by the simplified oral hygiene index. The children's mothers also answered a questionnaire about sociodemographic and medical history data. The variables were analyzed descriptively. Female participants were more prevalent (60.5%), and the mean age of the participants was 4.9 years (±1.4) (range: 2-8 years) and 92.1% of their exhibited some oral condition. All participants with CZS-associated microcephaly showed absence of lip sealing and had malocclusion (100.0%). When compared to the other groups, children with CZS had a higher percentage of dental anomalies (35.7%), mucosal changes (71.4%), and unsatisfactory oral hygiene (64.3%). In a sample composed mainly of female participants aged less than 5 years, the prevalence of oral conditions and unsatisfactory oral hygiene was higher in the group with CZS-associated microcephaly, followed by the group with non-CZS-associated microcephaly. Normotypical children had the highest percentage of dental caries experience.

Oral conditions of children with microcephaly associated with congenital Zika syndrome: a cross-sectional study

Abstract The aim of the present study was to compare the oral conditions of children with congenital Zika syndrome (CZS)-associated microcephaly, non-CZS-associated microcephaly, and normotypical children, as well as to characterize their sociodemographic aspects and medical history. A paired cross-sectional study was carried out on 14 children with CZS-associated microcephaly and 24 age-matched controls, in Belo Horizonte, in southeastern Brazil. Children's oral conditions were assessed: dental caries experience (dmft/DMFT indices); developmental defects of enamel (DDE) index; dental anomalies; mucosal changes; lip sealing, and malocclusion (overjet, overbite, and/or posterior crossbite alterations). The quality of oral hygiene was analyzed by the simplified oral hygiene index. The children's mothers also answered a questionnaire about sociodemographic and medical history data. The variables were analyzed descriptively. Female participants were more prevalent (60.5%), and the mean age of the participants was 4.9 years (±1.4) (range: 2-8 years) and 92.1% of their exhibited some oral condition. All participants with CZS-associated microcephaly showed absence of lip sealing and had malocclusion (100.0%). When compared to the other groups, children with CZS had a higher percentage of dental anomalies (35.7%), mucosal changes (71.4%), and unsatisfactory oral hygiene (64.3%). In a sample composed mainly of female participants aged less than 5 years, the prevalence of oral conditions and unsatisfactory oral hygiene was higher in the group with CZS-associated microcephaly, followed by the group with non-CZS-associated microcephaly. Normotypical children had the highest percentage of dental caries experience.

Oral paracoccidioidomycosis: a retrospective study of 95 cases from a single center and literature review

Background: The ecoepidemiological panorama of paracoccidioidomycosis (PCM) is dynamic and still ongoing in Brazil. In particular, data about the oral lesions of PCM are barely explored. The aim of this study was to report the clinicopathological features of individuals diagnosed with oral PCM lesions at an oral and maxillofacial pathology service in Rio de Janeiro, Brazil, in the light of a literature review. Material and methods: A retrospective study was conducted on oral biopsies obtained from 1958 to 2021. Additionally, electronic searches were conducted in PubMed, Embase, Scopus, Web of Science, Latin American and Caribbean Center on Health Sciences Information, and Brazilian Library of Dentistry to gather information from large case series of oral PCM. Results: Ninety-five cases of oral PCM were surveyed. The manifestations were more frequent among males (n=86/90.5%), middle-aged/older adults (n=54/58.7%), and white individuals (n=40/51.9%). The most commonly affected sites were the gingiva/alveolar ridge (n=40/23.4%) and lip/labial commissure (n=33/19.3%); however, one (n=40/42.1%) or multiple sites (n=55/57.9%) could also be affected. In 90 (94.7%) patients, "mulberry-like" ulcerations/moriform appearance were observed. Data from 21 studies (1,333 cases), mostly Brazilian (90.5%), revealed that men (92.4%; male/female: 11.8:1) and individuals in the fifth and sixth decades of life were the most affected (range: 7-89 years), with the gingiva/alveolar ridge, palate, and lips/labial commissure being the sites most frequently affected. Conclusions: The features of oral PCM lesions are similar to those reported in previous studies from Latin America. Clinicians should be aware of the oral manifestations of PCM, with emphasis on the clinicodemographic aspects and differential diagnoses, especially considering the phenomenon of the emergence of reported cases in rural and/or urban areas of Brazil. (AU)

Mucosite oral quimioinduzida: aspectos clínicos, laboratoriais, qualidade de vida, ansiedade e depressão / Chemotherapy-induced oral mucositis: clinical and laboratory aspects, quality of life, anxiety, and depression

O presente estudo é fundamentado em três objetivos: 1. sintetizar informações sobre ansiedade/depressão de indivíduos em regimes antineoplásicos que desenvolveram mucosite oral por meio de uma revisão sistemática da literatura; 2. avaliar o perfil de citocinas inflamatórias e a formação de redes extracelulares de neutrófilos em amostras de saliva de pacientes em quimioterapia e suas associações com mucosite oral; e 3. investigar ansiedade/depressão e qualidade de vida e associações com mucosite oral quimioinduzida. No primeiro estudo, buscas eletrônicas foram realizadas em cinco bases de dados, complementadas por escrutínio manual e pesquisas na literatura cinzenta. Oito estudos observacionais foram incluídos e a amostra analisada foi de 954 indivíduos. Sete instrumentos diferentes foram aplicados para mensurar ansiedade e/ou depressão. Associações de ansiedade e/ou depressão com a gravidade da mucosite oral foram observadas em 75,0% dos estudos. Os outros dois estudos foram análises longitudinais prospectivas com indivíduos adultos com diagnóstico de doenças hematolinfóides e em tratamento quimioterápico e/ou condicionamento para transplante de células-tronco hematopoiéticas no Hospital das Clínicas da Universidade Federal de Minas Gerais. Os níveis de citocinas inflamatórias (IL-1, IL-6, IL-8, TNF-α e TGF-ß1) e a formação de redes extracelulares de neutrófilos foram analisados por ELISA e identificação do complexo mieloperoxidase-DNA, respectivamente. As coletas de saliva foram realizadas em quatro momentos: dias D0, D3, D10 e D15. Dos 60 pacientes avaliados, 26 (43,3%) desenvolveram algum grau de mucosite oral. Os níveis de concentração de citocinas revelaram diferenças entre indivíduos com e sem mucosite oral. Concentrações significativamente maiores de IL-6 e TNF-α e menores concentrações de TGF-ß1 foram identificadas naqueles que desenvolveram mucosite oral. Houve uma diminuição na formação das redes extracelulares de neutrófilos entre aqueles que tiveram mucosite oral. Entretanto, não foram identificadas diferenças estatísticas entre as concentrações de citocinas e a formação de redes extracelulares de neutrófilos com variáveis clínicas e gravidade da mucosite oral. No terceiro estudo, os instrumentos Hospital Anxiety and Depression Scale, World Health Organization Quality of Life-BREF e Oral Health Impact Profile (versão abreviada ­ OHIP-14) foram aplicados a 37 pacientes nos dias D0 e D15. Aproximadamente 38% (n=14) dos indivíduos desenvolveram mucosite oral e obtiveram escores mais altos de ansiedade/depressão no início da análise. A mucosite oral teve um impacto negativo na qualidade de vida relacionada à saúde bucal, particularmente nas dimensões limitação funcional, dor física e incapacidade física. Em conjunto, os dados deste estudo contribuem para medidas preventivas e redução de comorbidades em pacientes com mucosite oral induzida por esquemas quimioterápicos. As citocinas inflamatórias participam do desenvolvimento da mucosite oral e podem ser úteis como biomarcadores na predição e monitoramento. Ademais, sintomas de ansiedade e depressão estão associados à mucosite oral que, por sua vez, afetam a saúde geral e a qualidade de vida relacionada à saúde bucal.

The present study is based on three purposes: 1. to synthesize by means of a systematic literature review information about anxiety/depression in individuals undergoing antineoplastic therapy who developed oral mucositis; 2. to evaluate the profile of inflammatory cytokines and neutrophil extracellular trap formation in salivary samples from patients undergoing chemotherapy and its associations with oral mucositis; and 3. to investigate anxiety/depression and quality of life and their associations with chemotherapy-induced oral mucositis. In the first study, electronic searches were conducted on five databases, complemented by manual scrutiny and grey literature searches in three other databases. Eight observational studies conducted on 954 individuals were included. Seven different instruments were applied to measure anxiety and/or depression. Associations of anxiety and/or depression with the severity of oral mucositis were observed in 75.0% of the studies. The other two studies were prospective longitudinal analyses of adult individuals diagnosed with hematolymphoid diseases and undergoing chemotherapy treatment and/or conditioning for hematopoietic stem-cell transplantation at the Hospital das Clínicas of Universidade Federal de Minas Gerais. The levels of inflammatory cytokines (IL-1, IL-6, IL-8, TNF-α, and TGF-ß1) and neutrophil extracellular trap formation were analyzed by ELISA and by the identification of the myeloperoxidase-DNA complex, respectively. Saliva sampling was performed at four time-points, i.e. days D0, D3, D10, and D15. Of the 60 patients evaluated, 26 (43.3%) developed some degree of oral mucositis. Cytokine concentration levels revealed differences between individuals with and without oral mucositis. Significantly higher concentrations of IL-6 and TNF-α and lower concentrations of TGF-ß1 were identified in those who developed oral mucositis. There was a decrease in neutrophil extracellular trap formation among those who experienced oral mucositis. However, no statistical differences were identified between cytokine concentrations or neutrophil extracellular trap formation and clinical variables or severity of oral mucositis. In the third study, the Hospital Anxiety and Depression Scale, World Health Organization Quality of Life-BREF and Oral Health Impact Profile (short-form ­ OHIP-14) were the instruments applied to 37 patients on days D0 and D15. Nearly 38% (n=14) of individuals developed oral mucositis and had higher anxiety/depression scores at baseline. Oral mucositis had a negative impact on quality of life related to oral health, particularly functional limitation, physical pain, and physical disability. Taken together, the data from this study contribute to the application of preventive measures and the reduction of comorbidities in patients with chemotherapy-induced oral mucositis. Inflammatory cytokines participate in the development of oral mucositis and may be useful as biomarkers in prediction and monitoring. Moreover, anxiety and depressive symptoms are associated with oral mucositis, affecting, in turn, overall health and oral health-related quality of life

Effects of tobacco on the DNA of smokers and non-smokers affected by OSCC: systematic review and meta-analysis

Abstract Scientific evidence about genetic and molecular changes in oral squamous cell carcinoma (OSCC) among smokers and non-smokers is inconclusive. This systematic review and meta-analysis assessed the effects of tobacco on the DNA of individuals with OSCC based on protein mutations. Electronic searches were conducted on PubMed, Ovid, Web of Science, and Scopus to identify observational studies published up to January/2022. The Joanna Briggs Institute tool was used for the critical appraisal of studies. The certainty of the evidence was evaluated. Twenty-three studies assessing 4,060 individuals (2,967 smokers vs. 1,093 non-smokers) were included in this review. Fifteen groups of proteins/genes were investigated. Analysis of the quality of articles revealed low risk of bias in most studies. The certainty of the evidence was very low. The meta-analysis confirmed no significant difference between smokers and non-smokers with respect to damage to GSTM1 (OR: 0.60; 95%CI: 0.30-1.18), GSTT1 (OR: 1.18; 95%CI:0.49-2.83), hydrolase proteins (Ku70 and Ku80) (OR: 0.74; 95%CI: 0.18-3.05), and transferase proteins (GSTM1, GSTT1, GSTM3) (OR: 0.74; 95%CI: 0.47-1.18). Most of the studies included showed that smokers are more likely to exhibit genetic instability. However, the meta-analysis revealed that smokers do not necessarily have more genetic alterations in the DNA than non-smokers.

Indices in dental image exams for bone mineral density evaluation of aromatase inhibitor users

Abstract We evaluated the accuracy of radiomorphometric indices (RI) and fractal dimension (FD) for screening bone mineral density (BMD) in postmenopausal patients who had breast cancer and were using aromatase inhibitors (AI). The sample consisted of 40 participants. Digital panoramic radiography (DPR) and cone beam computed tomography (CBCT) were evaluated along with dual-energy X-ray absorptiometry (DXA), which is the gold standard for detecting low BMD. According to the T-scores of DXA, the subjects were assigned into two groups: with normal BMD and with low BMD (osteopenia and osteoporosis). The area under the curve (AUC), sensitivity, and specificity with their respective confidence intervals were determined for DPR and CBCT. For DPR indices, AUC ranged from 52.6 to 75.8%. The mandibular cortical width (MCW) had the highest AUC. For FD, the total trabecular index had the highest sensitivity, while the index anterior to the mental foramen (MF) had the highest specificity. In CBCT, the AUC ranged from 51.8 to 62.0%. The indices with the highest AUC were the molar (M) and anterior (A). The symphysis (S) index had the highest sensitivity and the posterior (P) index had the highest specificity. Sensitivity and specificity were adequate for the computed tomography index (Inferior; CTI [I]). Therefore, MCW, FD of the mandible angle, and total trabecular ROI in DPR and the CTI (I), M, P, and A indices in CBCT proved to be promising tools in distinguishing individuals with low BMD. Cutoff point for these indices could be a useful tool to investigate low BMD in postmenopausal women taking AI.

Safety protocols for dental care during the COVID-19 pandemic: the experience of a Brazilian hospital service

Abstract The coronavirus disease (COVID-19) has been prioritized in relation to other illnesses considered critical, such as cancer, cardiovascular diseases/stroke, diabetes, and autoimmune diseases. The management of patients with these diseases involves dental care to reduce systemic complications caused by odontogenic infections, and/or to treat oral manifestations of systemic comorbidities. In this regard, the dental care of these individuals must be guaranteed during the pandemic. Although a high risk of exposure to and catching of COVID-19 is expected to befall dental professionals, biosafety guidelines reduce the likelihood of infection. Thus, the current scenario poses challenges, and offers decision-making approaches and tools that facilitate the management of individuals with oral manifestations of chronic and/or critical diseases, using hospital-based services. This article presents an overview for hospital service providers who are at the forefront of COVID-19 care, including a secure protocol, and clinical guidelines based on the experience of the Hospital das Clínicas in Belo Horizonte, a public referral service, supported by the Brazilian National Health System.

Solução de Carnoy no tratamento de ceratocisto / Carnoy's solution in treatment of keratocyst

Introdução: O objetivo do trabalho é relatar um caso de ceratocisto associado à impactação dentária, o qual foi tratado com descompressão, seguido de enucleação da lesão e utilização de solução de Carnoy. Relato de caso: Paciente do sexo masculino, 14 anos, encaminhado para avaliação de lesão encontrada após exame imaginológico de rotina. O mesmo demonstrou extensa lesão radiolúcida localizada na região de ângulo e ramo da mandíbula, com presença do elemento 48 intralesional próximo a basilar. Foi realizado biópsia incisional e instalação de dispositivo de descompressão no mesmo tempo cirúrgico, o qual o resultado histopatológico foi de ceratocisto. Após 6 meses com o dispositivo, observou-se diminuição da lesão e melhora no posicionamento do dente incluso. Frente a boa resposta à descompressão, decidiu-se pela enucleação total da lesão, exodontia dos dentes 47 e 48, curetagem rigorosa e tereapia adjuvante com aplicação da solução de Carnoy. O paciente evoluiu bem, neoformação óssea na área operada e encontra-se em acompanhamento há 6 meses, sem sinais de recidiva. Considerações finais: O uso da descompressão cirúrgica em lesões císticas mandibulares minimiza os danos as estruturas circunvizinhas, riscos de fratura patológica e lesão nervosa. Em função das altas taxas de recidiva, a terapia adjuvante após a enucleção é imprescindível para essa lesão, sendo a aplicação da solução de Carnoy uma das técnicas com melhores resultados. Dessa forma, para aumentar a taxa de sucesso e minimizar as sequelas, o planejamento cirúrgico dos ceratocistos mandibulares extensos deve ser feito de forma criteriosa e cuidadosa... (AU)

Introduction: The objective of this study is to report a case of keratocyst associated with dental impaction, which was treated with decompression, followed by enucleation lesion and Carnoy solution. Case report: Male patient, 14 years old, referred for evaluation of lesion found after routine imaging. He showed extensive radiolucent lesion located in the region of the angle and branch of the mandible, with the presence of the intralesional element 48 near the basilar. An incisional biopsy was performed and a decompression device was installed during surgical time and the histopathological result was keratocyst. After 6 months of observation a reduction of the lesion and improvement in the positioning of the tooth even were noticed. Given the good response to decompression, it was decided to complete the enucleation of the lesion, extraction of teeth 47 and 48, rigorous curettage and adjuvant therapy with Carnoy's solution. Followed up for 6 months, patient evolved well creating a new bone formation in the operated area with no signs of relapse. Final considerations: The use of surgical decompression in cystic mandibular lesions minimizes damage to surrounding structures, pathological fracture risks, and nerve damage. Because of the high rates of recurrence, keratocysts require adjuvant therapy after enucleation and Carnoy's solution is one of the best performing techniques. Thus, to increase success rate and minimize sequelae, the surgical planning of extensive mandibular keratocysts should be done carefully and judiciously... (AU)

Composite resin for restoration of a posterior tooth and polishing: clinical case report / Resina composta para restauração de um dente posterior e polimento: relato de caso clínico / Resina compuesta para restauración y pulido de diente posterior: reporte de caso

The aim of the present report was to describe a case of direct composite resin restoration in tooth 46, with emphasis on the importance of polishing. A 21-year-old female patient dissatisfied with the aesthetic amalgam restoration of her tooth 46 came to the our institution for correction of the situation. The procedure performed consisted of registration of occlusal contacts, selection of resin color, removal of amalgam restoration, coronal reconstruction with composite resin, occlusal adjustment, finishing and polishing, with the use of atomic force microscopy of the resin before and after polishing. A correct clinical protocol for the posterior composite resins is fundamental for the optimization of aesthetic results, for clinical performance and for consequent restorative longevity. The atomic force microscopy images of the resin used before and after polishing emphasize the necessity and clinical importance of this operative step(AU)

O objetivo do presente relato foi descrever um caso de restauração direta de resina composta no dente 46, com ênfase na importância do polimento. Paciente do sexo feminino, 21 anos, insatisfeita com a restauração estética de amálgama no seu dente 46, procurou nossa instituição para correção da situação. O procedimento realizado consistiu no registro dos contatos oclusais, seleção da cor da resina, remoção da restauração de amálgama, reconstrução coronária com resina composta, ajuste oclusal, acabamento e polimento, com o uso da microscopia de força atômica da resina antes e após o polimento. O protocolo clínico correto para as resinas compostas posteriores é fundamental para otimização dos resultados estéticos, para o desempenho clínico e consequente longevidade restauradora. As imagens de microscopia de força atômica da resina utilizada antes e após o polimento enfatizam a necessidade e a importância clínica desse procedimento(AU)

El objetivo del presente trabajo fué describir un caso de restauración directa con resina compuesta en el diente 46, destacando la importancia del pulido. Paciente de sexo femenino, 21 años, insatisfecha con la restauración de amalgama en el diente 46, buscó atención en nuestra institución. El procedimiento realizado consistió en registrar los contactos oclusales, selección del color de la resina, remoción de la restauración de amalgama, reconstrucción de la corona con resina compuesta, ajuste oclusal, acabado y pulido con el uso de microscópio de fuerza atómica en la resina antes y después del pulido. Un protocolo clínico correcto para el uso de resinas compuestas posteriores es fundamental para optimizar los resultados estéticos, para el desempeño clínico y consecuente longevidade de la restauración. Las imágenes del microscópio de fuerza atómica de la resina utilizada antes y después del pulido muestran la necesidad y la importancia clínica de usar ese procedimento(AU)

Investigation of different sodium hypochlorite volumes, concentrations and times of irrigation in endodontic therapy: a systematic review / Investigação de diferentes volumes, concentrações e tempos de irrigação do hipoclorito de sódio na terapia endodôntica: uma revisão sistemática / Investigación de diferentes volúmenes, concentraciones y tiempos de irrigación de hipoclorito de sodio en la terapia endodóntica: una revisión sistemática

Although the sodium hypochlorite (NaOCl) solution has been part of the endodontic arsenal for more than one century, current investigations have been unable to determine which NaOCl volume and concentration or which time of application are able to dissolve organic matter without weakening the dental structure during the phase of biomechanical preparation of the root canal. Thus, the objective of the present study was to conduct a systematic literature review with no restriction of publication year or language in order to resolve these questions. The search strategy included the following databases: PubMed, LILACS, Web of Science and ClinicalTrials.gov, and only in vivo human clinical trials were included in the final review. After the removal of duplicates, the systematic literature review yielded 3,717 articles. Of these, 3,685 were excluded after applying the exclusion criteria (ex vivo studies, animal studies, cell-culture studies, narrative review, and studies with no available full texts). A total of 32 full-text articles were assessed for eligibility. After evaluating the full text, all articles were excluded for different reasons. No studies fulfilled our inclusion criteria. This review was unable to answer what time of irrigation, concentration or volume of NaOCl solution can be of maximum effectiveness in endodontic treatment without producing significant changes in the mechanical properties of dentin. Thus, future human clinical studies are needed in order to resolve these questions(AU)

Embora a solução de hipoclorito de sódio (NaOCl) tem feito parte do arsenal endodôntico por mais de um século, as investigações atuais têm sido incapazes de determinar qual volume de NaOCl e concentração ou qual tempo de aplicação são capazes de dissolver a matéria orgânica sem enfraquecer a estrutura dentária durante a fase de preparação biomecânica do canal radicular. Assim, o objetivo do presente estudo foi realizar uma revisão sistemática da literatura, sem restrição de ano de publicação ou idioma para resolver estas questões. A estratégia de pesquisa incluiu os seguintes bancos de dados: PubMed, LILACS, Web of Science e ClinicalTrials.gov. Somente estudos in vivo foram incluídos na revisão final. Após a remoção de duplicatas, a revisão sistemática da literatura ofereceu 3.717 artigos. Destes, 3.685 foram excluídos depois dos critérios de exclusão aplicados (estudos ex vivos, estudos em animais, estudos de cultura de células, revisão narrativa e estudos com textos completos indisponíveis). Um total de 32 artigos com texto completo foram avaliados para elegibilidade. Depois de avaliar o texto completo, todos os artigos foram excluídos por razões diferentes. Não existiu estudos cumpridos nossos critérios de inclusão. Esta revisão foi incapaz de responder em que tempo de irrigação, concentração ou volume de solução de NaOCl podem apresentar máxima eficácia no tratamento endodôntico sem produzir mudanças significativas nas propriedades mecânicas da dentina. Assim, futuros estudos clínicos em humanos são necessários para responder essa pergunta(AU)

A pesar de que la solución de hipoclorito de sodio (NaOCl) ha sido parte del arsenal endodóntico por más de un siglo, las investigaciones actuales no han podido determinar el volumen exacto del NaOCl, concentración y el tiempo de aplicación capaces de disolver la materia orgánica sin debilitar la estructura dental durante la fase de preparación biomecánica del conducto radicular. El objetivo del presente estudio fue realizar una revisión sistemática de literatura, sin restricción de año de publicación o de idioma para responder estas preguntas. La estrategia metodológica utilizada fué consultar las siguientes bases de datos: PubMed, LILACS, Web of Science y ClinicalTrials.gov. Y se incluyeron solamente estudios in vivo en la presente revisión. Después de la eliminación de duplicados, la revisión sistemática tuvo 3.717 artículos. De estos, 3.685 fueron eliminados según los criterios de exclusión (estudios ex vivos, estudios en animales, estudios de cultivo de células, revisión narrativa y estudios con textos completos no disponibles). Un total de 32 artículos completos fueron escogidos y evaluados. Después de evaluar los textos completos, todos los artículos tuvieron que excluirse por diferentes razones. No fueron encontrados estudios cumpliendo con nuestros criterios de inclusión. Esta revisión no fue capaz de responder en qué tiempo de irrigación, concentración o volumen de solución de NaOCl puede presentar máxima eficacia en el tratamiento endodóntico sin alterar significativamente las propiedades mecánicas de dentina y disolver la matéria orgánica de los conductos radiculares. Siendo así, los futuros estudios clínicos en humanos se hacen necesarios para responder a nuestra pregunta(AU)

Cisto odontogênico calcificante: um estudo multicêntrico / Calcifying odontogenic cyst: a multicenter study

Este estudo investigou a frequência do cisto odontogênico calcificante (COC) submetido à análise histopatológica em diferentes regiões geográficas do Brasil. Em uma análise retrospectiva (1953-2016), arquivos de biópsias de 10 centros de Patologia Oral e Maxilofacial localizados em diferentes estados do Brasil: Goiás, Minas Gerais, Pará, Rio de Janeiro, Rio Grande do Norte, Rio Grande do Sul, Santa Catarina e São Paulo foram analisados. Dados demográficos, características clinicopatológicas, aspectos radiográficos e tipos de biópsia foram avaliados descritivamente. O teste Mann-Whitney foi utilizado para determinar a associação entre sintomas, tempo de evolução e tamanho da lesão. A significância estatística foi estabelecida como p<0,05. O diagnóstico do COC foi de acordo com a classificação da Organização Mundial de Saúde (2017). Adicionalmente, uma revisão da literatura de série de casos de COC foi realizada em quatro bases de dados eletrônicas (PubMed, Medline Ovid, Web of Science e Scopus). Dos 198.350 espécimes de biopsias exploradas, 268 casos de COC foram avaliados, representando 0,1% das lesões orais dos centros estudados. Em geral, indivíduos do sexo feminino (n=142, 54.0%), na segunda década de vida (n=76, 31.0%) com acometimento da maxila (n=141, 54.4%) foram os mais afetados. O tamanho médio das lesões dos indivíduos sintomáticos foi maior que o dos casos assintomáticos (p=0,026). A revisão da literatura apresentou maior frequência dos casos de COC na Ásia (186 casos) e na Europa (68 casos), acometendo principalmente os homens (n=247, 56.2%) na terceira década de vida. O COC é uma lesão rara. Novos dados sobre as características clinicopatológicas de 268 casos foram adicionados à literatura. Os dados referentes ao gênero e idade dos pacientes brasileiros aqui relatados são diferentes dos achados de séries de casos relatados já na literatura. Este estudo fornece informações que podem ajudar os clínicos, patologistas e cirurgiões no diagnóstico e manejo do COC.

This study investigated the frequency of calcifying odontogenic cyst (COC) submitted to histopathological analysis in different geographic regions of Brazil. In a retrospective analysis (1953-2016), biopsy files of 10 Oral and Maxillofacial Pathology centers located in different states of Brazil: Goiás, Minas Gerais, Pará, Rio de Janeiro, Rio Grande do Norte, Rio Grande do Sul, Santa Catarina and São Paulo were analyzed. Demographic data, clinicopathological characteristics, radiographic aspects and treatment were evaluated descriptively. The Mann-Whitney test was used to determine the association between symptoms, evolution time and lesion size. Statistical significance was set as p<0.05. The diagnosis of COC was according to the classification of the World Health Organization (2017). In addition, a literature review of case series was carried out in four electronic databases (PubMed, Medline Ovid, Web of Science and Scopus). Of 198,350 specimens of biopsies analyzed, 268 cases of COC were surveyed, representing 0.1% of the oral lesions at the centers studied. Overall, female patients (n=142, 54.0%) in their second decade of life (n=76, 31.0%) and the maxilla (n=141, 54.4%) were more affected. The mean lesion size of symptomatic individuals was larger than that of cases without symptoms (p=0.026). The literature review showed a higher frequency in Asia (186 cases) and Europe (68 cases), mainly affecting men (n=247, 56.2%) in the third decade of life. COC is a rare lesion. Additional data on the clinicopathological features of 268 cases have been added to the literature. Data regarding gender and age of the Brazilian patients reported herein are different with findings of case series and retrospective studies reported in the literature. This study provides information that could help clinicians, pathologists, and surgeons in the diagnosis and management of COC.

Photobiomodulation Therapy in Bone Repair Associated with Bone Morphogenetic Proteins and Guided Bone Regeneration: A Histomorphometric Study.

OBJECTIVE: To evaluate the efficacy of photobiomodulation for bone repair of critical surgical wounds with implants of bone morphogenetic proteins (BMPs) and bovine biological membranes, using histological and histomorphometric analysis. BACKGROUND: Tissue engineering has been developing rapidly through the use of various biomaterials for the treatment of bone defects, such as mechanical barriers consisting of biological membranes and implants of biomaterials for bone supply. MATERIALS AND METHODS: Thirty-two male rats were divided into four groups (n = 8): group I-C: control; group II-PT: photobiomodulation therapy; group III-PM: Gen-Pro® BMPs+Gen-Derm® membrane; and group IV-PMPT: Gen-Pro® BMPs+Gen-Derm® membrane+photobiomodulation therapy. A 3 mm bone cavity was performed in the upper third of the lateral surface of the right rat femur to obtain a bone defect considered to be critical. The irradiated groups received seven applications of AlGaAs diode laser 830 nm, P = 40 mW, continuous wave (CW) emission mode, f ∼ 0.6 mm, 4 J/cm2 per point (north, south, east, and west) at 48 h intervals, for a total of 16 J/cm2 per session (final dose: 112 J/cm2). Bone repair was evaluated at sacrifice 15 and 30 days after the procedure. The specimens were embedded in paraffin and stained with hematoxylin and eosin and Picrosirius for analysis by light microscopy and by the Leica interactive measurement module software. Statistical analysis was performed (p < 0.05%). RESULTS: Histological analysis confirmed the histomorphometric results, with the experimental groups showing bone neoformation of significantly higher quality and quantity at the end of 30 days compared with the control group. CONCLUSIONS: Photobiomodulation therapy was effective for bone repair mainly when associated with BMPs and a biological membrane. The results of this study are promising and stimulate further scientific and clinical research.

Immunohistochemical expression of TGF-ß1 and MMP-9 in periapical lesions.

The objective of this study was to evaluate the expression of matrix metalloproteinase 9 (MMP-9) and transforming growth factor beta (TGF-ß1) in periapical lesion samples correlated with the intensity of the inflammatory infiltrate and thickness of the epithelial lining. Forty-five cases of periapical lesions (23 periapical granulomas and 22 radicular cysts) were subjected to morphological and immunohistochemical analyses using anti-MMP-9 and anti-TGF-ß1 antibodies. The data were analyzed using the following tests: non-parametric Mann-Whitney, chi-square, Fisher's exact test and Spearman's correlation test (P<0.05). Analysis of inflammatory infiltrate revealed that 78% of periapical granulomas presented infiltrate grade III, in contrast with 32% of radicular cysts (P<0.001). Morphological evaluation of the epithelial thickness in radicular cysts revealed the presence of atrophic epithelium in 86% of the cysts. The immunostaining of MMP-9 was score 2 in 67% of the granulomas and 77% of the cysts. Both lesions were predominantly score 1 for TGF-ß1. Significant differences were confirmed between the expression scores of TGF-ß1 and MMP-9 in periapical granulomas (p = 0.004) and in radicular cysts (p < 0.001). Expression of TGF-ß1 was different for periapical granulomas and radicular cysts. This immunoregulatory cytokine seems more representative in asymptomatic lesions. The extracellular matrix remodeling process dependent on MMP-9 seems to be similar for both periapical granulomas and radicular cysts. TGF-ß1 and MMP-9 may play an important role in the maintenance of periapical lesions.

Immunohistochemical expression of TGF-ß1 and MMP-9 in periapical lesions

Abstract The objective of this study was to evaluate the expression of matrix metalloproteinase 9 (MMP-9) and transforming growth factor beta (TGF-β1) in periapical lesion samples correlated with the intensity of the inflammatory infiltrate and thickness of the epithelial lining. Forty-five cases of periapical lesions (23 periapical granulomas and 22 radicular cysts) were subjected to morphological and immunohistochemical analyses using anti-MMP-9 and anti-TGF-β1 antibodies. The data were analyzed using the following tests: non-parametric Mann-Whitney, chi-square, Fisher's exact test and Spearman's correlation test (P<0.05). Analysis of inflammatory infiltrate revealed that 78% of periapical granulomas presented infiltrate grade III, in contrast with 32% of radicular cysts (P<0.001). Morphological evaluation of the epithelial thickness in radicular cysts revealed the presence of atrophic epithelium in 86% of the cysts. The immunostaining of MMP-9 was score 2 in 67% of the granulomas and 77% of the cysts. Both lesions were predominantly score 1 for TGF-β1. Significant differences were confirmed between the expression scores of TGF-β1 and MMP-9 in periapical granulomas (p = 0.004) and in radicular cysts (p < 0.001). Expression of TGF-β1 was different for periapical granulomas and radicular cysts. This immunoregulatory cytokine seems more representative in asymptomatic lesions. The extracellular matrix remodeling process dependent on MMP-9 seems to be similar for both periapical granulomas and radicular cysts. TGF-β1 and MMP-9 may play an important role in the maintenance of periapical lesions.

Síndrome de Stevens-Johnson associada à alopurinol e nimesulida: relato de caso / Stevens-Johnson Syndrome associated with allopurinol and nimesulide: case report

A síndrome de Stevens-Johnson (SSJ) é uma variante do eritema multiforme pela conformação e distribuição das lesões cutâneas e maior gravidade do envolvimento mucoso. É caracterizada pela ação de anticorpos IgG ou IgM específicos para drogas. Apresenta importante papel na Odontologia pois que muitas vezes as primeiras manifestações desta doença ocorrem na mucosa bucal. O objetivo deste trabalho é apresentar um relato de um paciente portador da SSJ, sexo masculino, 53 anos, com queixa inicial de dor e ardência bucal. Ao exame clínico verificou-se lesões e crostas hemorrágicas evidentes no vermelhão dos lábios e mucosa bucal. Relatou que foi atendido anteriormente em um serviço oftalmológico e diagnosticado com conjuntivite e que estava sob uso das seguintes medicações: alopurinol, nimesulida, sinvastatina, omeprazol e frontal. O quadro do paciente evoluiu rapidamente para as lesões em pele e por esta razão internado e submetido a protocolo do setor de queimados de um hospital particular. Atualmente o paciente apresenta as seguintes sequelas: cegueira do olho esquerdo, simbléfaro e pterígio nasal. O conhecimento dessa síndrome, pelo cirurgião-dentista é de fundamental importância, vez que, o estabelecimento do diagnóstico precoce pode minimizar as sequelas e até mesmo evitar casos extremos de óbito. Por fim, esclarecer e conscientizar os profissionais quanto ao uso indiscriminado de medicamentos, causa hoje reconhecida para esta síndrome... (AU)

The Stevens-Johnson syndrome (SJS) is a variant of erythema multiforme by the conformation and distribution of skin lesions and more severe mucosal involvement. It is characterized by the action of specific drugs for IgG or IgM antibodies. Plays an important role in dentistry since often the first manifestations of this disease occur in the oral mucosa. The objective of this paper is to present a report of a patient with SJS, male, 53 years, with an initial complaint of pain and burning mouth. On clinical examination there was injury and hemorrhagic crusts evident in the vermilion of the lips and buccal mucosa. Reported that previously serviced on an eye care center and diagnosed with conjunctivitis and was under use of the following medications: allopurinol,nimesulide, simvastatin, omeprazole and front. The patient's condition progressed rapidly to skin lesions and for this hospital and subjected to the burning of a private hospital sector protocol reason. Currently the patient has the following consequences: blindness of the left eye, nasal pterygium and symblepharon. Knowledge of this syndrome, the dentist is crucial, since the establishment of early diagnosis can minimize sequelae and even prevent extreme cases death. Finally, clarify and educate professionals about the indiscriminate use of medicines, now recognized to cause this syndrome... (AU)