Eficácia do propionato de clobetasol 0, 05 nas lesões ulceradas da cavidade bucal / Efficacy of 0.05% clobetasol propionate in ulcerated lesions of the oral cavity

O uso tópico de Propionato de Clobetasol 0,05% em solução aquosa para lesões ulceradas na cavidade bucal é pouco divulgado nacionalmente e tem sido pouco citado em traba-lhos científicos a respeito de sua eficácia, tempo de regressão da lesão e efeitos adversos. Portanto, o objetivo deste estudo foi avaliar retrospectivamente prontuários de pacientes que foram tratados de lesões ulceradas através do uso do Propionato de Clobetasol 0,05%, no ambulatório de estomatopatologia de uma Instituição, a fim de investigar sua eficácia. Foram selecionados prontuários de pacientes que apresentaram a alteração fundamental ulcerada ou erosiva e que fizeram o uso tópico de Propionato de Clobetasol 0,05%. A aná-lise retrospectiva foi feita por um examinador, que fez a seleção da amostra seguindo os critérios de inclusão e exclusão. Foram coletadas as informações: Idade, gênero, diagnós-tico da alteração; quantidade de lesão, tempo de uso, evolução da lesão, tempo exato de regressão e presença de reações adversas. Foram incluídos 17 prontuários, dos quais cinco eram de pacientes com lesões erosivas de líquen plano, três úlceras traumáticas, três lesões liquenóides, dois eritemas multiformes, uma alergia a lactose, uma afta e uma gengivite descamativa. Todos os casos apresentaram resolução da sintomatologia, porém as altera-ções clínicas permaneceram em seis casos, embora mais leves e assintomáticas. Não foi ob-servada nenhuma reação adversa registrada no prontuário. A análise estatística não apontou associação em relação ao sexo (teste Exato de Fisher; p=0,49; p>0,05). Não foi observada diferença estatística significativa na frequência das lesões (teste exato de Fisher; p= 0,85; p>0,05). O uso do Propionato de Clobetasol 0,05% prescrito por até cinco dias se mostrou eficaz no tratamento de lesões ulceradas da mucosa bucal, principalmente para o alívio sintomático, além disso, não revelou efeitos adversos.

The treatment of ulcerated lesions of the oral cavity is usually carried out using topical analgesic drugs, anti-inflammatory corticosteroids, and alcohol-free oral antiseptics. The topical use of 0.05% Clobetasol Propionate in aqueous solution for ulcerated lesions in the oral cavity is little publicized nationally and little mentioned in scientific studies regarding its effectiveness, lesion regression time, and adverse effects. Therefore, the objective of this study was to retrospectively evaluate the medical records of patients who were treated for ulcerated or erosive lesions, using Clobetasol Propionate 0.05%, in the stomatology clinic of an institution to investigate its effectiveness. Medical records of patients who presented the fundamental ulcerated alteration and made topical use of 0.05% Clobetasol Propionate were selected. An examiner selected the sample following the inclusion and exclusion cri-teria and performed the retrospective analysis. The types of information collected were age, gender, diagnosis of the disorder, amount of injury, time of use, the evolution of the injury, exact time of regression, and presence of adverse reactions. A total of 17 medical records were included, of which five were from patients with erosive lichen planus lesions, three traumatic ulcers, three lichenoid lesions, two multiform erythema, one lactose allergy, one cold sore, and one scaly gingivitis. All cases had their symptoms solved, but, in six cases, the clinical changes remained, although milder and asymptomatic. No adverse reaction was noted in the medical record. The statistical analysis showed no association in relation to gender (Fisher's exact test; p = 0.49; p> 0.05). There was no statistically significant diffe-rence in the frequency of injuries (Fisher's exact test; p = 0.85; p> 0.05). The use of 0.05% Clobetasol Propionate, prescribed for up to five days, proved effective in treating ulcerated lesions of the oral mucosa, mainly for symptomatic relief. Furthermore, it revealed no ad-verse effects.

Avaliação de anomalias dentárias em terceiros molares através de tomografia computadorizada de feixe cônico / Evaluation of dental anomalies in third molars using cone beam computed tomography

Objetivo: A proposta deste estudo foi determinar a prevalência das anomalias dentárias em terceiros molares. Materiais e métodos: O estudo foi feito de modo transversal e retros-pectivo através da análise das tomografias computadorizadas de feixe cônico (TCFC) de pacientes com os terceiros molares. As anomalias dentárias foram investigadas e registra-das em tabela previamente desenhada para o estudo. Foram registradas outras informações como: sexo e idade. Resultados:151 exames de TCFC foram incluídos na amostra, totali-zando 308 terceiros molares avaliados. Dos 308 terceiros molares avaliados, 105 apresen-taram anomalias (37,7%). A anomalia dentária mais prevalente foi a dilaceração radicular, apresentando 96 casos (34,5%), seguida de 5 casos de microdontia (1,79%), 3 casos de hi-percementose (1,07%) e 1 pérola de esmalte (0,35%). Conclusão: A partir deste estudo foi observado que as anomalias em terceiros molares são comuns. Além disso, a dilaceração foi a anomalia mais prevalente na amostra estudada, sendo importante o cirurgião-dentista utilizar exames de imagem no planejamento de uma extração dentária.

Objective: The purpose of this study was to determine the prevalence of dental anomalies in third molars. Materials and methods: This cross-sectional and retrospective study analyzed the cone-beam computed tomography (CBCT) of patients with third molars. Dental anomalies were investigated and recorded in a table previously designed for the study. Other information such as sex and age were registered. Results: 151 patients were included in the sample, totaling 308 third molars evaluated. Out of 308 teeth, 105 had anomalies (37.7%). The most prevalent dental anomaly was the root tear, 96 cases (34.5%). The second was microdontia, 5 cases (1.79%); hypercementosis, 3 cases (1.07%); and enamel pearl, 1 case (0 .35%). Conclusion:We observed that third molar anomalies are common and that laceration was the most prevalent anomaly in the sample. Thus, dentists need to use imaging tests in planning a tooth extraction.

Treatment of bisphosphonate-related osteonecrosis using platelet-rich plasma: microtomographic, microscopic, and immunohistochemical analyses.

The present study aimed to investigate the use of platelet-rich plasma (PRP) on tooth extraction sites in rats treated with bisphosphonates. Thirty Albinus Wistar male rats were administered 0.035 mg/kg zoledronic acid intravenously for 8 weeks, divided into four administrations with a 2-week interval between each application, after which their upper right central incisors were extracted to induce the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). The samples were divided into the following two groups: Group 1 (G1) underwent marginal resection of BRONJ followed by the use of PRP, while Group 2 (G2) underwent resection of BRONJ but without the use of PRP. The treatment groups were evaluated after 14, 28, and 42 days. Clinical, microtomographic, microscopic, and immunohistochemical (IHC) evaluations were performed. Microtomography results revealed no significant difference between the groups (p <0.05) in any time period. Histomorphometric analysis showed increased bone formation over time for both groups (p < 0.001). G1 demonstrated a greater amount of new bone formation than G2 at 28 and 42 days (p < 0.001), with G1 presenting greater vascularization and a slightly higher VEGF expression. For both groups, RANKL/OPG expression levels were sufficient as a parameter for indicating the rate of bone remodeling in a previously treated area of osteonecrosis groups. Taken together, our findings indicated that the use of PRP improves the resolution process of BRONJ.

Clinical outcomes of pterygoid implants: Systematic review and meta-analysis.

The aim of this systematic literature review was to analyze clinical outcomes of pterygoid implant for the treatment of patients with atrophic posterior maxillae and to provide clinical recommendations for this dental implant technique. An extensive search of electronic databases (PubMed/Medline, Science Direct, Lilacs, Embase, and Cochrane Library) was conducted, for articles published between January 1995 and January 2018, to identify literature presenting clinical outcomes of pterygoid implants in the treatment of patients with atrophic posterior maxillae. The systematic review was performed in accordance with PRISMA/PICO statement guidelines, and the risk of bias was assessed (Australian National Health and Medical Research Council scale). The relative risk of implant failure was analyzed within a 95% confidence interval (95% CI). After screening 331 abstracts from the electronic databases, 36 full-text articles were accessed for eligibility, and a total of 6 studies were included in this systematic review (after applying the inclusion and exclusion criteria). All studies were retrospective in nature and were classified with a poor level of evidence. A total of 634 patients received 1.893 pterygoid implants, with a mean implant survival rate of 94.87%. The mean prevalence of implant failure was 0.056 with a 95% CI of 0.04-0.077. This study demonstrates that pterygoid implants can be successfully used in patients with atrophic posterior maxilla. However, the results should be interpreted with caution, given the presence of uncontrolled confounding factors in the included studies.

Treatment of bisphosphonate-related osteonecrosis using platelet-rich plasma: microtomographic, microscopic, and immunohistochemical analyses

Abstract The present study aimed to investigate the use of platelet-rich plasma (PRP) on tooth extraction sites in rats treated with bisphosphonates. Thirty Albinus Wistar male rats were administered 0.035 mg/kg zoledronic acid intravenously for 8 weeks, divided into four administrations with a 2-week interval between each application, after which their upper right central incisors were extracted to induce the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). The samples were divided into the following two groups: Group 1 (G1) underwent marginal resection of BRONJ followed by the use of PRP, while Group 2 (G2) underwent resection of BRONJ but without the use of PRP. The treatment groups were evaluated after 14, 28, and 42 days. Clinical, microtomographic, microscopic, and immunohistochemical (IHC) evaluations were performed. Microtomography results revealed no significant difference between the groups (p <0.05) in any time period. Histomorphometric analysis showed increased bone formation over time for both groups (p < 0.001). G1 demonstrated a greater amount of new bone formation than G2 at 28 and 42 days (p < 0.001), with G1 presenting greater vascularization and a slightly higher VEGF expression. For both groups, RANKL/OPG expression levels were sufficient as a parameter for indicating the rate of bone remodeling in a previously treated area of osteonecrosis groups. Taken together, our findings indicated that the use of PRP improves the resolution process of BRONJ.

Medication-related osteonecrosis of the jaw, osteoradionecrosis, and osteomyelitis: A comparative histopathological study.

It is largely known that some oral diseases can be diagnosed based upon their clinical manifestation combined with the patient's medical history and generally not depending on examination. This is the case of some bone diseases such as osteoradionecrosis of the jaw (ORNJ), osteomyelitis of the jaw (OMJ), and medication-related osteonecrosis of the jaw (MRONJ). The present study aimed to analyze the histopathological features of these specific bone diseases in order to evaluate similarities and differences. Forty-four bone specimens resected from each bone disease (22 cases of ORNJ, 6 cases of OMJ, and 16 cases of MRONJ) were analyzed by two experienced oral pathologists without prior knowledge of the diagnosis, considering bone tissue condition, inflammation, vascularization, and the presence of microorganisms. In addition, the examiners formulated a diagnostic hypothesis for each specimen. Many histopathological similarities were found among the diseases, especially considering the presence of necrotic bone, inflammation, and microorganisms. Statistically significant differences were detected in empty bone lacunae, which was decreased in ORN (p = 0.042), and considering neutrophil count, which was low in the MRONJ group (p ≤ 0.001). The Kappa coefficient was calculated and agreement was detected based on the histopathological parameters, but not for diagnostic suggestion (p=0.23). In conclusion, histopathological aspects of ORNJ, OMJ, and MRONJ do not permit a conclusive diagnosis, emphasizing the necessity of a detailed clinical report.

Estudo retrospectivo da osteonecrose dos maxilares associada ao uso de bisfosfonatos sem exposição óssea clínica / Retrospective study of osteonecrosis of maxillars associated with the use of biphosphonates without clinical bone exposure

Introdução: a osteonecrose dos maxilares associada ao uso de bisfosfonatos (OMMBF) é uma complicação bucal importante. Com o relato de casos clínicos atípicos, os quais apresentaram a OMMBF, o rompimento da mucosa bucal adjacente se encontrou ausente, levantou-se discussão sobre essa variante clínica. Objetivo: avaliar casos de osteonecrose medicamentosa dos maxilares (OM), sem exposição óssea clínica, diante da escassez de investigações sobre essa variante clínica. Metodologia: Após o parecer favorável do Comitê de Ética, foram avaliados, retrospectivamente, 35 prontuários e exa mes radiográficos de pacientes com o diagnóstico de OM. Foram incluídos no estudo somente os casos de OM sem exposição óssea clínica e excluídos os pacientes que foram tratados através de radioterapia de cabeça e pescoço, além dos que apresentaram exposição óssea clínica. Através dos prontuários selecionados, foram coletadas as seguintes informações: idade e gênero do paciente, tipo de doença sistêmica, tipo de bisfosfonato, tempo de uso do bisfosfonato, forma de administração do medicamento. Análise radiográfica foi realizada utilizando radiografia panorâmica. Os maxilares foram divididos em sextantes para avaliação da presença de: osteólise, sequestro ósseo, esclerose óssea, reação periosteal, anormalidades na lâmina dura, presença de fratura patológica. Resultados: apenas cinco pacientes foram incluídos neste estudo, sendo todos oncológicos e do gênero feminino. A idade média foi de 57.6 meses, o tipo de bisfosfonato foi o Zometa, administrado de forma intravenosa, com o tempo médio de 114 meses. Com relação ao estudo radiográfico, esclerose óssea foi a alteração mais encontrada, seguida de osteólise e anormalidades da lâmina dura. A mandíbula foi mais afetada que a maxila. Conclusão: através deste estudo, foi concluído que pacientes com OM associada ao uso de bisfosfonatos, sem exposição óssea, apresentaram alterações radiográficas importantes, enfatizando a importância de uma análise radiográfica criteriosa em pacientes que fazem o uso de drogas antirreabsortivas, na tentativa de prevenir ou diagnosticar precocemente as alterações ósseas.

Introduction: osteonecrosis of the jaw associated with the use of bisphosphonates (OMMBF) is an important oral complication. With the report of atypical clinical cases, which presented the OMMBF with absent rupture of the adjacent oral mucosa raised discussion about this clinical variant. Objective: the aim of this study was to evaluate cases of Medication-related osteonecrosis of the jaw (OM) without clinical bone exposure, given the paucity of research on this clinical variant. Methods: following the favorable decision of Ethics Committee, it was evaluated, retrospectively, medical records and panoramic radiographs of patients diagnosed with OM. The study included only cases of OM without clinical bone exposure. Patients treated by head and neck radiation therapy or presenting clinical bone exposure were excluded. Through the selected records were collected the following information: age and gender of the patient, type of systemic disease, type of bisphosphonate, time of use and its administration. Radiographic analysis was performed using panoramic radiograph. The jaws were divided into sextants to assess the presence of: osteolysis, bone sequestration, bone sclerosis, periosteal reaction, abnormalities in the lamina dura, presence of pathological fracture. Results: only five patients were included in this study, all of oncological and female. The average age was 57.6 months, the type of bisphosphonate Zometa was administered intravenously with the average time of 114 months. Regarding the radiographic study, bone sclerosis was the most frequent finding, followed by osteolysis and abnormalities of the lamina dura. The mandible was more affected than the maxilla. Conclusion: through this study, it was concluded that patients with OM without bone exposure, present significant radiographic changes, emphasizing the importance of radiographic analysis in patients who make use of antiresorptive drugs in an attempt to prevent or diagnose early bone changes.

Medication-related osteonecrosis of the jaw, osteoradionecrosis, and osteomyelitis: A comparative histopathological study

Abstract It is largely known that some oral diseases can be diagnosed based upon their clinical manifestation combined with the patient's medical history and generally not depending on examination. This is the case of some bone diseases such as osteoradionecrosis of the jaw (ORNJ), osteomyelitis of the jaw (OMJ), and medication-related osteonecrosis of the jaw (MRONJ). The present study aimed to analyze the histopathological features of these specific bone diseases in order to evaluate similarities and differences. Forty-four bone specimens resected from each bone disease (22 cases of ORNJ, 6 cases of OMJ, and 16 cases of MRONJ) were analyzed by two experienced oral pathologists without prior knowledge of the diagnosis, considering bone tissue condition, inflammation, vascularization, and the presence of microorganisms. In addition, the examiners formulated a diagnostic hypothesis for each specimen. Many histopathological similarities were found among the diseases, especially considering the presence of necrotic bone, inflammation, and microorganisms. Statistically significant differences were detected in empty bone lacunae, which was decreased in ORN (p = 0.042), and considering neutrophil count, which was low in the MRONJ group (p ≤ 0.001). The Kappa coefficient was calculated and agreement was detected based on the histopathological parameters, but not for diagnostic suggestion (p=0.23). In conclusion, histopathological aspects of ORNJ, OMJ, and MRONJ do not permit a conclusive diagnosis, emphasizing the necessity of a detailed clinical report.

Reabilitação dentária e reconstrução mandibular com retalho microvascularizado de fíbula / Dental rehabilitation and mandibular reconstruction with microvascularized fibular flap

Introdução: O tratamento do ameloblastoma mandibular, um tumor odontogênico benigno, é controverso para suas variantes patológicas (uni ou multicístico). Curetagem e amplas ressecções ósseas ocasionam defeitos ósseos que comprometem estética e função do paciente. Relato de caso: Paciente 48 anos, gênero masculino, submetido à ressecção segmentar de mandíbula devido a ameloblastoma multicístico em região de sínfise e para sínfise foi reabilitado funcional e esteticamente com implantes dentários após reconstrução mandibular com enxerto ósseo microvascularizado de fíbula. Conclusão: O retalho microvascularizado de fíbula foi eficaz na reconstrução mandibular após ressecção de ameloblastoma e, quando associado a implantes dentários, permitiu reabilitação estomatognática e melhora estética significativas... (AU)

Introduction: Treatment of mandibular ameloblastoma, a benign odontogenic tumor, is controversial for its pathological variants (single or multicystic). Curettage and bone resections lead to large bone defects that compromise the aesthetics and function of the patient. Case report: Patient 48 years, male, underwent segmental resection of the jaw due to multicystic ameloblastoma in symphysis region. It was functionally and aesthetically restored with dental implants after mandibular reconstruction with micro- vascularized fibular bone graft. Conclusion:The microvascularized fibular flap was effective in mandibular reconstruction after amelobastoma resection and, when associated with dental implants, allowed stomathognatic rehabilitation and significant aesthetic improvement... (AU)

Radiographic Findings in Patients with Medication-Related Osteonecrosis of the Jaw.

A retrospective study was conducted of the records and panoramic radiographs of 35 patients treated with bisphosphonates (BP) and diagnosed with MRONJ. Panoramic radiography was used for evaluation, by two examiners, the following findings were subject of search: osteolysis (OT), cortical bone erosion (EC), bone sclerosis focal (FS) and diffuse (DS), bone sequestration (BS), thickening of lamina dura (TD), prominence of the inferior alveolar nerve canal (IAN), persisting alveolar sockets (SK), and the presence of a pathological fracture (PF). Medical information and staging were also recorded in order to correlate with radiographic findings. Bone sclerosis was the most frequent alteration, followed by OT and TD. The mandible was more affected than the maxilla. There was no significant difference between genders or significant correlation between the number of injuries with age and duration of BP usage. Considering the association between the radiographic findings and MRONJ staging, EC was predominant in stage 3 and DS in stage 2. IAN and PF demonstrated greater association with stage 3. In conclusion, the higher the clinical staging, the greater the severity of the bone alteration. Panoramic radiographic examination is a useful screening tool in patients submitted to antiresorptive therapy.

Simple bone cyst in a 7-year-old child / Cisto ósseo simples em criança de 7 anos

ABSTRACT The simple bone cyst,or traumatic bone cyst, solitary or idiopathic bone cavity is an intraosseous pseudocyst discovered through a panoramic radiographic examination. Commonly, the SBC is presented as an asymptomatic lesion, radiolucent, unilocular, without cortical expansion, with margins adorning vital tooth roots of the affected region. The literature has recommended that clinical and radiographic aspects of simple bone cyst are quite convincing as to diagnosis, so follow-up through clinical and radiographic examination has been suggested. This case illustrates an exuberant clinical case of simple bone cyst, which was presented as multilocular and expansive lesion in a 7-year-old patient. Surgical exploration was performed because her parents were anxious about the presumptive diagnosis of other more aggressive lesions. The diagnosis of SBC was confirmed. The case was monitored and, after three years, total bone remodeling of the affected area was observed. In conclusion, asymptomatic radiolucent lesions that suggest a strong presumptive diagnosis of a simple bone cyst can be clinically and radiographically monitored. However, clinical variations, as in the present clinical case, require confirmation of the diagnosis, which is performed through exploratory surgery. The establishment of the diagnosis affords the safest approach for both the professional and the patient.

RESUMO O cisto ósseo simples, ou cisto ósseo traumático, solitário ou cavidade óssea idiopática é um pseudocisto intra-ósseo descoberto através de um exame radiográfico panorâmico. Comumente, o cisto ósseo simples se apresenta como uma lesão assintomática, radiolúcida, unilocular, sem expansão de corticais, com margens festonando as raízes dentárias vitais da região afetada. A literatura tem recomendado que os aspectos clínicos e radiográficos do cisto ósseo simples são bastante convincentes do seu diagnóstico, portanto a proservação através de exame clínico e radiográfico tem sido sugerida. O presente caso ilustra um caso clínico de um grande cisto ósseo simples, o qual se apresentava multilocular e expansivo, numa criança de 7 anos. Diante da ansiedade dos pais e diagnóstico presuntivo de outras lesões mais agressivas, foi realizada a exploração cirúrgica, a qual confirmou o diagnóstico de cisto ósseo simples. O caso foi acompanhado e, após três anos, foi observada a total remodelação óssea da área afetada. Como conclusão, as lesões radiolúcidas assintomáticas que sugerirem um diagnóstico presuntivo muito indicativo de cisto ósseo simples, podem ser acompanhadas clínica e radiograficamente. Entretanto, as variações de apresentação clínica, como no presente caso clínico, requerem uma confirmação do diagnóstico, a qual é realizada através da exploração cirúrgica. O estabelecimento do diagnóstico torna a condução do caso mais segura para ambos o profissional e o paciente.

Delayed tongue necrosis simultaneous with bilateral osteoradionecrosis of the jaw secondary to head and neck irradiation.

We present a rare case of massive tongue necrosis occurring simultaneously with bilateral osteoradionecrosis (ORN) of the jaw in a patient with a history of treatment, including surgery and postoperative radiotherapy, for a retromolar trigone carcinoma 8 years earlier. There is a distinct possibility that the extractions and administration of local anesthesia with a vasoconstrictor contributed to the onset of ORN; together, these events may have influenced the blood supply to the tongue. A glossectomy was performed after hyperbaric oxygen therapy. One month after the surgical procedure, the patient responded satisfactorily to the treatment, showing significant improvement in speech and oral food intake, as well as significant decrease in lingual pain. Although the simultaneous occurrence of these oral complications is rare, the practitioner must be aware of the factors that instigate ORN and compromise vasculature as well as the clinical signs of tongue necrosis. Additionally, the possibility of tongue necrosis secondary to irradiation of the head and neck should be taken into consideration when an irradiated patient undergoes tooth extractions under local anesthesia with agents containing epinephrine.

Lesão traumática severa em paciente internado em UTI / Severe traumatic injury in hospitalized patient in the intensive care unit

Introdução: a Odontologia vem conquistando um espaço fundamental no ambiente hospitalar, especialmente nas Unidades de Terapia Intensiva (UTI), onde o cirurgião-dentista (CD) atua em diversas situações, sendo desde o diagnóstico de patologias bucais até os diversos procedimentos necessários para a saúde bucal e a manutenção da qualidade de vida do paciente. Dentre as complicações bucais que podem ocorrer em paciente desse perfil estão as lesões traumáticas, que quando presentes, requerem tratamento e acompanhamento odontológico. Objetivo: o presente caso ilustra a atuação do CD em uma UTI neurológica onde uma paciente em estadio avançado de câncer de mama apresentou uma úlcera traumática em lábio inferior requerendo planejamento preventivo e tratamento para a afecção. Método: trata-se de um relato de caso com método descritivo. Resultados e Discussão: a paciente seguiu acompanhada pela equipe de um Hospital privado que assistia aos pacientes uma vez ao dia, entretanto, quando ocorreu um novo trauma não havia um CD de plantão e a gravidade foi maior. Conclusão: diante disso, com este artigo enfatizamos a importância da presença integral de um CD na UTI com o intuito de minimizar as complicações bucais e proporcionar melhor qualidade de vida ao paciente.

Introduction: dentistry has been gaining a fundamental place in the hospital environment, especially in Intensive Care Units (ICUs), where the dental surgeon (CD) acts in several situations, ranging from the diagnosis of oral pathologies to the various procedures required for oral health And maintenance of the patient's quality of life. Among the oral complications that may occur in patients with this profile are traumatic lesions, which, when present, require dental treatment and follow-up. Objective: the present case illustrates the performance of CD in a neurological ICU where an advanced stage breast cancer patient presented a traumatic ulcer on the lower lip requiring preventive planning and treatment for the condition. Method: this is a case report with a descriptive method. Results and Discussion: the patient was followed by the staff of a private hospital who attended the patients once a day. However, when a new trauma occurred, there was not on-call CD and the severity was greater. Conclusion: therefore, with this article we emphasize the importance of the integral presence of a CD in the ICU in order to minimize oral complications and provide a better quality of life for the patient.

Metástase oral de adenocarcinoma de cólon: relato de caso / Oral metastasis of colon adenocarcinoma: case report

Introdução: as lesões metastáticas em boca são raras e representam menos de 1% de todas as neoplasias malignas. A mandíbula é a região mais afetada e, os tecidos moles, menos comumente, sendo a gengiva e a língua os sítios mais acometidos. Objetivo: relatar um caso clínico de um paciente portador de adenocarcinoma de cólon avançado sob cuidados paliativos, e que apresentou uma lesão metastática bucal. Método: relado de caso. Resultado e Discussão: O diagnóstico precoce de lesões metastáticas bucais é bastante desafiador para o cirurgião-dentista, uma vez que essas lesões podem manifestar-se clinicamente como lesões reacionais ou neoplasias benignas, que podem dificultar o diagnóstico precoce e seu imediato tratamento. Ressaltamos que o exame físico da boca deve ser realizado em pacientes oncológicos, que apresentam metástases em outros órgãos, no intuito de investigar a existência de lesões bucais e proporcionar um diagnóstico precoce, que possibilite melhor chance de tratamento e reabilitação mais favorável, quando o prognóstico do câncer é bom. Conclusão: nos casos avançados, o tratamento paliativo deve ser realizado para que haja melhor qualidade de vida ao paciente.

Introduction: metastatic lesions in the mouth are rare and account for less than 1% of all malignancies. The jaw is the most affected region, and the soft tissues are less commonly, with the gingiva and tongue being the most affected sites. Objective: the objective of this study is to report a case of a patient with advanced colon adenocarcinoma under palliative care and who presented with an oral metastatic lesion. Method: it is proposed a standard vase report. Result and Discussion: early diagnosis of oral metastatic lesions is quite challenging for the dental surgeon, since these lesions may manifest clinically as reactional lesions or benign neoplasms, which may make early diagnosis and immediate treatment. We emphasize that the physical examination of the mouth should be performed in cancer patients, who have metastases in other organs, in order to investigate the presence of oral lesions and provide an early diagnosis, which allows a better chance of treatment and more favorable rehabilitation, when the prognosis of cancer is good. Conclusion: in advanced cases, palliative treatment should be performed in order to have a better quality of life for the patient.

Medication-related osteonecrosis of the jaw. Introduction of a new modified experimental model.

PURPOSE: To evaluate a modified experimental model for medication-related osteonecrosis of the jaw (MRONJ) through the upper right central incisor extraction followed by intravenous bisphosphonate administration. METHODS: Forty five rats underwent the upper right central incisor tooth extraction were divided in 2 groups: Group I - experimental group, 30 rats received an intravenous administration protocol of zoledronic acid 35µg/kg into the tail vein every two weeks, totalizing four administrations, during eight weeks of administration, previously the extraction, and Group II - control group, 15 rats didn't received any medication before extraction. The groups were subdivided in postoperative periods: 14/28/42 days. Clinical analysis and microtomography were performed to verify the presence of osteonecrosis. In addition, descritive histological analysis of hematoxylin-eosin stained sections was performed to evaluate the presence of osteonecrosis or necrotic foci. RESULTS: Twelve (40%) rats, from experimental group, showed clinical signs of MRONJ (p=0.005), however, all samples showed imaginologic findings like osteolysis and loss of integrity of the cellular walls (p≤0.001). Microscopic evaluation revealed osteonecrosis areas with microbial colonies and inflammatory infiltrate (p≤0.001). In the control group, all animals presented the chronology of a normal wound healing. CONCLUSIONS: The presence of medication-related osteonecrosis of the jaw after maxillary central incisor extraction in rats. This new experimental model may be considered an option for the study of MRONJ.

Medication-related osteonecrosis of the jaw. Introduction of a new modified experimental model

ABSTRACT PURPOSE : To evaluate a modified experimental model for medication-related osteonecrosis of the jaw (MRONJ) through the upper right central incisor extraction followed by intravenous bisphosphonate administration. METHODS: Forty five rats underwent the upper right central incisor tooth extraction were divided in 2 groups: Group I - experimental group, 30 rats received an intravenous administration protocol of zoledronic acid 35μg/kg into the tail vein every two weeks, totalizing four administrations, during eight weeks of administration, previously the extraction, and Group II - control group, 15 rats didn't received any medication before extraction. The groups were subdivided in postoperative periods: 14/28/42 days. Clinical analysis and microtomography were performed to verify the presence of osteonecrosis. In addition, descritive histological analysis of hematoxylin-eosin stained sections was performed to evaluate the presence of osteonecrosis or necrotic foci. RESULTS: Twelve (40%) rats, from experimental group, showed clinical signs of MRONJ (p=0.005), however, all samples showed imaginologic findings like osteolysis and loss of integrity of the cellular walls (p≤0.001). Microscopic evaluation revealed osteonecrosis areas with microbial colonies and inflammatory infiltrate (p≤0.001). In the control group, all animals presented the chronology of a normal wound healing. CONCLUSIONS: The presence of medication-related osteonecrosis of the jaw after maxillary central incisor extraction in rats. This new experimental model may be considered an option for the study of MRONJ.

Histopathologic and Histomorphometric Analysis of Irradiation Injury in Bone and the Surrounding Soft Tissues of the Jaws.

PURPOSE: Surgery of irradiated tissue has an increased complication rate because of the development of hypovascular, hypocellular, and hypoxic tissue. This study was undertaken to perform histopathologic and histomorphometric analyses of irradiation tissue injury in bone and the surrounding soft tissues. MATERIAL AND METHODS: The histopathologic findings of 40 human mandibular bones and the surrounding soft tissue specimens obtained from different patients who underwent surgical procedures for treatment of osteoradionecrosis of the jaws were reviewed. RESULTS: Histopathologic examination showed 7 processes in the following order of appearance: hyperemia, endarteritis, thrombosis, cell loss, hypovascularity, increase of fat in the bone marrow cavity, and fibrosis. Histomorphometric analysis showed significant hypocellularity (P = .007), hypovascularity (P < .001), and fibrosis (P < .001) in irradiated specimens compared with control specimens. CONCLUSION: These results showed that radiation injuries affect the bone and surrounding soft tissues. However, the irradiation-induced injuries, such as cellular loss (hypocellularity) and fibrosis, were more expressive in bone tissue than in the surrounding soft tissues.

Surgical management of bisphosphonate-related osteonecrosis of the jaws: literature review.

PURPOSE: Surgical management of bisphosphonate-related osteonecrosis of the jaws (BRONJ) has been performed in an attempt to increase healing rates of the affected cases. This literature review aimed to identify clinical studies of surgical management of bisphosphonate-related osteonecrosis of the jaws (BRONJ) in order to assess their surgical treatment modalities, outcome and the follow-up. METHODS: A search in the PubMed (Medline) database using specific terms and/or phrases as "bisphosphonate-related osteonecrosis" or "jaw osteonecrosis", and "surgical treatment" or "surgical management" was conducted in order to identify clinical trials and cases of surgical treatment of BRONJ. The review search covered the time period from 2004 to 2014. All studies identified in the search were selected according to the inclusion criteria. Relevant information was recorded according to the following items: author, year, number of patients, BRONJ clinical stage, surgical treatment modality, clinical success, and follow-up. RESULTS: The initial database search yielded 345 titles. After filtering, 67 abstracts were selected culminating in 67 full text articles. A variety of surgical approach was found in this review: debridement, sequestrectomy bone resection, and bone reconstruction. Adjunctive therapies included hyperbaric oxygen, laser therapy, growth factors, and ozone. CONCLUSION: Although there are many indexed studies about BRONJ, well-documented reports concerning surgical therapeutically techniques are scarce, resulting from a lack of well-established protocols. Considerable differences were found regarding sample size, surgical treatment modalities and outcomes. Clinical studies with larger number of patients and longer follow-up are required to provide best information for each surgical treatment modality and its outcomes.

Late-onset adverse reactions related to hyaluronic Acid dermal filler for aesthetic soft tissue augmentation.

Hyaluronic acid (HA) fillers have been the choice material for soft tissue augmentation in the last decade. Although they are considered safe, there could be adverse reactions in the subsequent months or years to the treatment. However, these reactions have hardly ever been reported in the literature. This article considers 2 cases of delayed adverse reactions related to HA dermal filler for soft tissue augmentation with oral manifestation. It should be, before all, emphasized that HA filler is a safe and well-recognized treatment for soft tissue augmentation, despite the fact that delayed adverse effects may later occur after treatment, and clinicians should be aware of it when establishing a definitive oral diagnosis.

Retrospective study of pterygoid implants in the atrophic posterior maxilla: implant and prosthesis survival rates up to 3 years.

PURPOSE: Few reports have evaluated cumulative survival rates of implants placed in the pterygoid region in the medium term. The objective of this study was to evaluate success rates of pterygoid implants and prostheses in patients treated in the atrophic posterior maxilla. MATERIALS AND METHODS: A retrospective study was performed of patients with an atrophic posterior maxilla rehabilitated with pterygoid implants between 1999 and 2010 and followed for at least 36 months after implant loading. Two outcome variables were considered: implant success and prosthesis success. The following predictor variables were recorded: sex, age, implant placement angulation, number and size of implants, prosthetic rehabilitation, bone loss, date of prosthesis delivery, and date of last follow-up. A statistical model was used to estimate the survival rates and associated confidence intervals. Data were analyzed using the Kaplan-Meier method and log-rank test to compare survival curves. RESULTS: A total of 238 titanium implants (172 anterior and 66 pterygoid) were placed in 56 patients. The 3-year overall pterygoid implant survival rate was 99%. The 3-year overall prosthesis survival rate was 97.7%. The mean bone loss around pterygoid implants after 3 years of loading was 1.21 mm (range, 0.31 to 1.75). All patients were wearing the prostheses at the most recent follow-up examination. CONCLUSION: Placement of implants in the pterygoid region is a viable alternative treatment modality for rehabilitation of patients with an atrophic posterior maxilla.