Malignant tumors affecting the head and neck region in ancient times: Comprehensive study of the CRAB Database.

In the modern world, cancer is a growing cause of mortality, but archeological studies have shown that it is not exclusive to modern populations. The aim of this study is to examine the epidemiologic, social, and clinicopathologic features of head and neck cancers in ancient populations. To do this, we extracted all records that described malignant lesions in the head and neck region available in the Cancer Research in Ancient Bodies Database (CRAB). The estimated age, sex, physical condition of the remains (skeletonized, mummified), anatomic location of tumors, geographic location, chronology, tumor type, and methods of tumor diagnosis were collected. One hundred and sixty-seven cases were found, mostly originating from Europe (51.5%). Most records were of adults between 35 and 49 years of age (37.7%). The most involved site was the skullcap (60.4%), and the most common malignancies were metastases to the bone (65.3%) and multiple myeloma (17.4%). No primary soft tissue malignancies were registered. The results of our study indicate that head and neck cancers were present in ancient civilizations, at least since 500,000 BCE. The available data can help to improve the current understanding of the global distribution of head and neck cancer and its multidimensional impacts on populations in the contemporary world.

Malignant tumors affecting the head and neck region in ancient times: Comprehensive study of the CRAB Database

Abstract In the modern world, cancer is a growing cause of mortality, but archeological studies have shown that it is not exclusive to modern populations. The aim of this study is to examine the epidemiologic, social, and clinicopathologic features of head and neck cancers in ancient populations. To do this, we extracted all records that described malignant lesions in the head and neck region available in the Cancer Research in Ancient Bodies Database (CRAB). The estimated age, sex, physical condition of the remains (skeletonized, mummified), anatomic location of tumors, geographic location, chronology, tumor type, and methods of tumor diagnosis were collected. One hundred and sixty-seven cases were found, mostly originating from Europe (51.5%). Most records were of adults between 35 and 49 years of age (37.7%). The most involved site was the skullcap (60.4%), and the most common malignancies were metastases to the bone (65.3%) and multiple myeloma (17.4%). No primary soft tissue malignancies were registered. The results of our study indicate that head and neck cancers were present in ancient civilizations, at least since 500,000 BCE. The available data can help to improve the current understanding of the global distribution of head and neck cancer and its multidimensional impacts on populations in the contemporary world.

Manejo odontológico del paciente con anemia falciforme: revisión integrativa / Dental management of the patient with falciform anemia: integrative review / Manejo odontológico do paciente com anemia falciforme: revisão integrativa

La anemia falciforme (AF) es un trastorno genético autosómico recesivo que afecta la hemoglobina y los glóbulos rojos adquieren una forma de hoz. Este evento provoca episodios de vaso-oclusión y hemólisis y, en consecuencia, una amplia gama de manifestaciones clínicas. Objetivo: realizar una revisión bibliográfica integrativa sobre el cuidado dental para pacientes con anemia falciforme. Materiales y Métodos: Se realizó una búsqueda en las bases de datos de PubMed y SciELO, utilizando como estrategia una asociación de tér-minos relacionados ("Anemia de Células Falciformes" y " Atención Odontológica"). Resultados: Se incluyeron los artículos publicados a partir de 1990 y se excluyeron revisiones de literatura, lo que resultó en dieciocho artículos para análisis. La evidencia científica demostró que la atención odontológica preventiva es esencial para los pacientes con anemia falciforme, ya que puede reducir el número de ingresos hospitalarios. Las me-didas previas, durante y posteriores al tratamiento pueden incluir profilaxis antibiótica, uso de sedación, buen control de los niveles de oxígeno, hidratación del paciente y mantenimiento de una perfusión tisular adecuada. Sin embargo, persisten algunas dudas, sobre la seguridad del uso de anestésicos locales con vasoconstric-tores y la oseointegración de implantes dentales. Conclusión: El conocimiento de la enfermedad es esencial para el tratamiento dental de pacientes con anemia falciforme; durante la atención, se debe tener en cuenta ciertos cuidados para reducir los factores que promueven crisis agudas como acidosis, hipotensión, hipoxia, infección, vasoconstricción y estrés.

Sickle cell anemia (SCA) is an autosomal recessive genetic disorder that affects the hemoglobin molecule of red blood cells in sickle-shaped cells formation. This event causes vaso­occlusive crises and hemolysis, and consequently, a wide range of clinical manifestations. Objective: This study aimed to present an integrative review of the literature on dental care of patients with SCA. Material and Methods: A search was conducted in Pubmed and Scielo databases using as a search strategy an association of terms related to disease and dentistry ("Sickle Cell Anemia", "Dental Care"). Results: Studies published since 1990 were included while literature reviews were excluded, resulting in eighteen articles for analysis. The literature has shown that pre-ventive dental care is essential for patients with sickle cell anemia and is able to reduce the number of hospi-talizations. Pre, trans and post-treatment measures may include antibiotic prophylaxis, use of sedation, good control of oxygen levels, patient hydration, and maintenance of adequate tissue perfusion. Still, more studies are needed to clarify some dental uncertainties during the care given to patients with AF, such as the safety of local anesthetics with vasoconstrictors and the use of osseointegrated implants. Conclusion: The knowledge of the disease is essential for dental management. Certain precautions should be taken to reduce factors that promote acute crises, such as acidosis, hypotension, hypoxia, infection, vasoconstriction and stress.

A anemia falciforme (AF) é uma alteração genética autossômica recessiva que afeta a molécula de hemoglo-bina das hemácias, resultando na formação de células em forma de foice. Esse evento provoca episódios de vaso-oclusão e hemólise, e consequentemente, uma ampla gama de manifestações clínicas. Objetivo: Este trabalho teve como objetivo apresentar uma revisão integrativa de literatura sobre os cuidados odontológicos ao paciente com anemia falciforme. Materiais e Métodos: Foi conduzida uma busca nas bases de dados Pubmed e Scielo, utilizando-se como estratégia uma associação de termos relacionados à doença e à odon-tologia ("Anemia Falciforme" e "Assistência Odontológica"). Resultados: Foram incluídos artigos publicados a partir de 1990 e excluídas revisões de literatura, resultando em dezoito artigos para análise. A literatura mostrou que o atendimento odontológico preventivo é essencial para o paciente com anemia falciforme, sendo capaz de diminuir a quantidade de internações hospitalares. As medidas pré, trans e pós-tratamento podem incluir a profilaxia antibiótica, o uso de sedação, um bom controle dos níveis de oxigênio, a hidratação do paciente e a manutenção da perfusão tecidual adequada. No entanto, algumas dúvidas persistem como a segurança dos anestésicos locais com vasoconstritor e a instalação de implantes osseointegrados. Con-clusão: O conhecimento da doença é primordial para o manejo odontológico desses pacientes e, durante o atendimento, certos cuidados devem ser tomados para diminuir os fatores que promovem as crises agudas como a acidose, hipotensão, hipóxia, infecção, vasoconstrição e estresse.

Late hyaluronidase injection in local anesthesia: Morphofunctional evaluation in rat sciatic nerve block.

INTRODUCTION: Despite the enhancing effects of hyaluronidase (HYAL) over duration of anesthesia, this enzyme could cause adverse effects when injected concomitantly with local anesthetics in dental blocks. OBJECTIVE: This study aimed to assess the tissue alterations caused by a local anesthetic protocol consisting of a late HYAL injection and confirm its functional effectiveness. MATERIALS AND METHODS: The protocol efficacy was proved by evaluating sensory and motor functions in rats. The sciatic nerve was blocked with 2% lidocaine (LID) with epinephrine (n = 25). Thirty minutes later, 75 TRU/ml HYAL was injected into the same site (experimental group, LID/HYAL). One week later, this protocol was repeated in the contralateral hindlimb, injecting only HYAL's vehicle (control group, LID/vehicle [LID/V]). To observe the integrity of the local tissues, histological specimens were obtained 1, 24, 48, and 72 h after treatment with LID/HYAL or LID/V (n = 16 each) and stained with hematoxylin/eosin and picrosirius red. RESULTS: Local inflammation was similar in both groups. The integrity of the nerve fibers was preserved, in spite of some inflammation-associated injuries in the surrounding tissues. The reversible tissue disorganization caused by HYAL, probably facilitated the diffusion of the residual anesthetic to the nerve, resulting in a prolonged anesthetic effect (P < 0.05). CONCLUSIONS: No irreversible morphological alterations are caused by the administration of HYAL prior the end of the LID-induced block. Moreover, this protocol prolongs LID's anesthetic effect.

Neuromonitorización intraoperatoria del nervio facial: a propósito de un caso / Intraoperative neuromonitoring of the facial nerve: a case report

Introdução: A preservação do nervo facial (NF) é uma das principais preocupações do cirurgião durante o tratamento aberto das fraturas mandibulares, uma vez que uma lesão nessa estrutura anatômica pode causar sequelas estéticas e funcionais permanentes. A existência de variações anatômicas (anastomoses e ramificações incomuns) aumenta o risco de danos no NF, mesmo nas mãos de cirurgiões experientes. O neuromonitoramento intraoperatório tem-se mostrado um grande aliado para evitar lesões nos ramos nervosos que podem estar envolvidos na área cirúrgica. Considerando a escassez desse assunto na literatura referente à cirurgia maxilo-facial, objetivamos demonstrar o uso da técnica de neuromonitoração do NF durante o acesso submandibular para o tratamento da fratura bilateral do ângulo mandibular. Relato de caso: No presente relato de caso, as abordagens cirúrgicas de ambos os lados não apresentaram danos permanentes ao NF. Esse resultado assim como a literatura sugerem que o neuromonitoramento intraoperatório proporciona maior segurança durante a realização de abordagens cirúrgicas, nas quais os ramos do nervo facial estão envolvidos, reduzindo, assim, o risco de sequelas nervosas. Considerações Finais: Esse recurso pode ser de grande auxílio no treinamento hospitalar ao longo do processo de formação de cirurgiões bucomaxilofaciais... (AU)

Introduction: Facial nerve (FN) preservation is one of the surgeon's major concerns during the open treatment of mandibular fractures since an injury to this anatomical structure can cause permanent aesthetic and functional sequelae. The existence of anatomical variations (anastomosis and unusual branching) increases the risk of FN damage even in the hands of experienced surgeons. Intraoperative neuromonitoring has proven to be a great ally to avoid injury to the nerve branches that may be involved in the surgical area. Considering the scarcity of this subject in the maxillofacial surgery literature, we aimed to demonstrate the use of the FN neuromonitoring technique during the submandibular approach for the treatment of bilateral mandibular angle fracture. Case report: In the present case report, the surgical approaches of both sides presented no permanent damage to the FN. Results: This result, as well as previous literature, suggests that intraoperative neuromonitoring provides greater safety during the performance of surgical approaches in which the facial nerve branches are involved and thus, reduces the risk of nerve sequelae. Final considerations: This resource can be of special assistance in teaching hospitals throughout the training process of maxillofacial surgeons... (AU)

Guaiacol/ß-cyclodextrin for rapid healing of dry socket: antibacterial activity, cytotoxicity, and bone repair-an animal study.

PURPOSE: Dry socket (DS) is one the most common and symptomatic post-extraction complications; however, no consensus on its treatment has been reached. This study aimed to develop a novel dressing material for DS containing the phenolic agent guaiacol and evaluate its biological properties. METHODS: An inclusion complex of guaiacol and ß-cyclodextrin (Gu/ßcd) was prepared by freeze-drying. Its antibacterial activity over six oral bacteria was analyzed using the microdilution method, and its cytotoxicity in osteoblasts was assessed with the MTT assay. The alveolar healing process induced by Gu/ßcd was evaluated histologically after the treatment of DS in rats. RESULTS: ßcd complexation potentiated Gu's antibacterial effect and reduced its cytotoxicity in osteoblasts. Bone trabeculae were formed in the alveolar apices of rats treated with Gu/ßcd by day 7. On day 14, woven bone occupied the apical and middle thirds of the sockets; on day 21, the entire alveolus was filled by newly formed bone, which was in a more advanced stage of repair than the positive control (Alvogyl™). CONCLUSION: The improvement in Gu's biological properties in vitro and the rapid alveolar repair in comparison with Alvogyl™ in vivo demonstrated the benefits of the Gu/ßcd complex as a future alternative for the treatment of DS.

O efeito dos inibidores seletivos da recaptação da serotonina no metabolismo ósseo e sua influência na odontologia / The effect of selective serotonin reuptake inhibitors on bone metabolism and its influence on dentistry

Objetivo: o presente trabalho teve como objetivo apresentar uma revisão do conhecimento atual do efeito dos inibidores seletivos da receptação da serotonina (ISRSs) sobre os ossos e sua influência na Odontologia, especialmente nos procedimentos dependentes da qualidade óssea, como na Implantodontia. Material e métodos: um levantamento bibliográfico foi realizado nas bases de dados Scielo e PubMed, utilizando-se as palavras-chave "antidepressivo", "inibidores seletivos da recaptação da serotonina", "osso" e "Odontologia". Foram selecionados artigos publicados de 2000 a 2018 nos idiomas inglês, português, espanhol e francês. Resultados: foram incluídos 26 artigos na presente revisão qualitativa. A maior parte dos estudos sugere que os ISRSs exercem um efeito negativo sobre a densidade óssea e aumentam o risco de fraturas, especialmente em indivíduos idosos. Na Implantodontia, os usuários de ISRSs apresentaram taxas de falha maiores que as dos não usuários, porém, sem diferença estatisticamente significante. Durante a movimentação ortodôntica, um único estudo mostrou que os ISRSs não produzem alterações, e na doença periodontal há resultados contraditórios em relação ao efeito protetor ou destruidor dos ISRSs. Conclusão: os ISRSs podem diminuir a densidade óssea corporal e prejudicar sua arquitetura. Embora não exista uma evidência sedimentada sobre a influência dos ISRSs no osso alveolar, sugere-se que maiores cuidados sejam tomados em pacientes usuários de ISRSs que serão submetidos a procedimentos dependentes da qualidade óssea, como no caso dos implantes osseointegrados. (AU)

Objetive: the objective of the present study was to present a review of the current knowledge of the effect of selective serotonin reuptake inhibitors (SSRIs) on bone and its infl uence on dentistry, especially on procedures dependent on bone quality, such as dental implants. Material and methods: a literature review was performed in the databases Scielo and PubMed, using the keywords "antidepressant", "selective serotonin reuptake inhibitors", "bone", and "dentistry". Articles published between 2000 and 2018, in English, Portuguese, Spanish and French were selected. Results: twenty-six articles were included in the present qualitative review. Most studies suggest that SSRIs exert a negative effect on bone density and increase the risk of fractures, especially in elderly. In implant dentistry, SSRI users presented higher failure rates than non-users, however, with no statistically significant difference. During orthodontic movement, a single study showed that SSRIs do not produce changes, and in periodontal disease there are contradictory results regarding the protective or destructive effect of SSRIs. Conclusion: SSRIs can decrease body bone density and impair its architecture. Although there is no settled evidence on the influence of SSRIs on the alveolar bone, it is suggested that greater care should be taken in SSRI users who will undergo bone quality-dependent procedures, such as osseointegrated implants. (AU)

Comparación entre la piezocirugía y los instrumentos rotativos convencionales en la lateralización del nervio dentario inferior / Comparison between the piezosurgery and the conventional rotary surgery in the lateralization of the inferior alveolar nerve

Introducción: la rehabilitación de pacientes desdentados mandibulares posteriores con implantes osteointegrados, se vuelve difícil cuando la cresta alveolar presenta una atrofia severa debido al recorrido superficial del canal mandibular. La lateralización del nervio dentario inferior es una alternativa terapéutica que posibilita la colocación de implantes convencionales y cortos en esta región. Objetivo: comparar la facilidad, efectividad y seguridad de la técnica quirúrgica convencional, realizada con fresas quirúrgicas, y la piezocirugía en la lateralización del nervio dentario inferior. Presentación del caso: paciente con ausencia bilateral de los molares inferiores y cresta alveolar atrófica fue tratada mediante lateralización del nervio dentario inferior y colocación simultánea de implantes. En el lado izquierdo, la lateralización fue realizada con fresas y en el lado derecho, con motor piezoeléctrico. Fue posible observar que la piezocirugía facilitó la técnica quirúrgica, y consecuentemente disminuyó el tiempo operatorio. A la vez, produjo una osteotomía más regular y con menos sangrado, lo cual mejoró la visualización del campo operatorio. Finalmente, el daño neural inmediato fue menor en el lado tratado con motor piezoeléctrico y con recuperación más rápida. Después de 3 meses de seguimiento, los implantes en ambos lados no presentaban pérdida ósea. Conclusiones: el uso del motor piezoeléctrico trajo más beneficios durante la lateralización del nervio dentario inferior, por la simplificación de la técnica quirúrgica y la reducción del sangrado y del daño neural en comparación con el uso de fresas convencionales(AU)

Introduction: the rehabilitation of edentulous posterior mandibular patients with bone-integrated implants becomes difficult when the alveolar crest presents a severe atrophy due to the superficial course of the mandibular canal. The inferior alveolar nerve lateralization is a therapeutic alternative that allows the placement of conventional and short implants in this region. Objective: to compare the easiness, effectiveness, and safety of the conventional surgical technique, performed with surgical drills, and piezosurgery in the lateralization of the inferior alveolar nerve. Case presentation: a patient with bilateral absence of the lower molars and atrophic alveolar crest was treated by lateralization of the inferior alveolar nerve and simultaneous implant placement. On the left side, the lateralization was made with drills and on the right side, with an electric piezotome. It was possible to observe that the piezosurgery facilitated the surgical technique, and consequently decreased the operative time. At the same time, it produced a more regular osteotomy and with less bleeding, which improved the visualization of the operative field. Finally, the immediate neural damage was lower on the side treated with the electric piezotome and with faster recovery. After 3 months of follow-up, the implants on both sides did not show bone loss. Conclusions: the use of the electric piezotome brought more benefits during the lateralization of the inferior alveolar nerve, by the simplification of the surgical technique and the reduction of bleeding and neural damage in comparison with the use of conventional drills(AU)

Comparación entre la piezocirugía y los instrumentos rotativos convencionales en la lateralización del nervio dentario inferior / Comparison between the piezosurgery and the conventional rotary surgery in the lateralization of the inferior alveolar nerve

Introducción: la rehabilitación de pacientes desdentados mandibulares posteriores con implantes osteointegrados, se vuelve difícil cuando la cresta alveolar presenta una atrofia severa debido al recorrido superficial del canal mandibular. La lateralización del nervio dentario inferior es una alternativa terapéutica que posibilita la colocación de implantes convencionales y cortos en esta región. Objetivo: comparar la facilidad, efectividad y seguridad de la técnica quirúrgica convencional, realizada con fresas quirúrgicas, y la piezocirugía en la lateralización del nervio dentario inferior. Presentación del caso: paciente con ausencia bilateral de los molares inferiores y cresta alveolar atrófica fue tratada mediante lateralización del nervio dentario inferior y colocación simultánea de implantes. En el lado izquierdo, la lateralización fue realizada con fresas y en el lado derecho, con motor piezoeléctrico. Fue posible observar que la piezocirugía facilitó la técnica quirúrgica, y consecuentemente disminuyó el tiempo operatorio. A la vez, produjo una osteotomía más regular y con menos sangrado, lo cual mejoró la visualización del campo operatorio. Finalmente, el daño neural inmediato fue menor en el lado tratado con motor piezoeléctrico y con recuperación más rápida. Después de 3 meses de seguimiento, los implantes en ambos lados no presentaban pérdida ósea. Conclusiones: el uso del motor piezoeléctrico trajo más beneficios durante la lateralización del nervio dentario inferior, por la simplificación de la técnica quirúrgica y la reducción del sangrado y del daño neural en comparación con el uso de fresas convencionales(AU)

Introduction: the rehabilitation of edentulous posterior mandibular patients with bone-integrated implants becomes difficult when the alveolar crest presents a severe atrophy due to the superficial course of the mandibular canal. The inferior alveolar nerve lateralization is a therapeutic alternative that allows the placement of conventional and short implants in this region. Objective: to compare the easiness, effectiveness, and safety of the conventional surgical technique, performed with surgical drills, and piezosurgery in the lateralization of the inferior alveolar nerve. Case presentation: a patient with bilateral absence of the lower molars and atrophic alveolar crest was treated by lateralization of the inferior alveolar nerve and simultaneous implant placement. On the left side, the lateralization was made with drills and on the right side, with an electric piezotome. It was possible to observe that the piezosurgery facilitated the surgical technique, and consequently decreased the operative time. At the same time, it produced a more regular osteotomy and with less bleeding, which improved the visualization of the operative field. Finally, the immediate neural damage was lower on the side treated with the electric piezotome and with faster recovery. After 3 months of follow-up, the implants on both sides did not show bone loss. Conclusions: the use of the electric piezotome brought more benefits during the lateralization of the inferior alveolar nerve, by the simplification of the surgical technique and the reduction of bleeding and neural damage in comparison with the use of conventional drills(AU)

La toxina botulínica como adyuvante en el tratamiento de la sonrisa gingival / Botulinum toxin as an adjuvant in the treatment of gummy smile

RESUMEN: La búsqueda de la excelencia estética es un objetivo importante de la odontología. La sonrisa gingival es una de las principales quejas estéticas, ya que perjudica la autoestima y las relaciones sociales del paciente. Nuevas técnicas como la aplicación de la toxina botulínica (TB) pueden tornarse una opción terapéutica más conservadora, y ayudar a disminuir las proporciones de las intervenciones quirúrgicas resectivas. El propósito de este trabajo es describir la aplicación de la TB como adyuvante de la cirugía gingival resectiva, a través del reporte de un caso clínico de discrepancia dentogingival y sonrisa gingival. Con la cirugía resectiva el equilibrio dentogingival fue mejorado, y la aplicación de TB tipo A causó la dehiscencia uniforme del labio superior, devolviendo la armonía facial. La TB es un complemento útil y conservador en la mejora estética de la sonrisa, y puede aumentar los resultados de la cirugía gingival resectiva.

ABSTRACT: The search for aesthetic excellence is an important goal in dentistry. The gummy smile is one of the main aesthetic complaints as it can affect self-esteem, and prejudice the patients' social relationships. New techniques, such as the application of botulinum toxin (BT) may become a more conservative treatment option and help to reduce the proportions of resective surgery. The purpose of this paper is to describe the application of BT, used as an adjuvant to gingival resection surgery, using a case report of a dento-gingival discrepancy and gummy smile. The resection surgery improved the dento-gingival equilibrium and the application of BT led to a uniform dehiscence of the upper lip, and facial harmony. BT is a useful and conservative adjuvant in the aesthetic enhancement of the smile, and can improve the outcomes of gingival resection surgery.