Morphometric aspects and proposal of a new classification of genial tubercles in cone-beam computed tomography in a Brazilian population.

Objective: This study evaluated epidemiological and morphological aspects of genial tubercles (GTs) using cone-beam computed tomography (CBCT). Methods: This retrospective, observational and cross-sectional study evaluated 276 tomographs of adult dentate individuals (18-69 years). The presence and absence of GTs were evaluated, and in cases in which this structure was observed, linear measurements (length, height, and width), and anatomical distances. In addition, a GT classification was proposed based on the presence, number, and location of the tubercles. Results: Of the 276 CT scans, 28 (10.14%) had absence of GTs and in 248 CT scans GTs were present, of which 42 (57.5%) were from females and 106 (42.5%) from males. Regarding the number of GTS, the most prevalent variant was the two-tubercle-variant (143, 57.7%), followed by the presence of a single tubercle (n = 62, 25.0%), 3 tubercles (n = 40, 16.1%) and 4 tubercles (n = 3, 1.2%). The most prevalent classification was IIIA (n = 96, 38.7%), followed by IIIB (n = 60, 36.3%), IIA (n = 53, 21.4%) and IIB (n = 9, 3.6%). Conclusion: A prevalence of GT of approximately 90% was observed, with two GTs per exam as the most frequent finding. Men had a longer mean GT length compared to women. Female individuals exhibited a shorter distance from the base of the GT to the base of the mandible.

Development and validation of a new formula for sex estimation based on multislice computed tomographic measurements of maxillary and frontal sinuses among Brazilian adults.

OBJECTIVES: To evaluate the accuracy of the measurements of the maxillary sinus (MS) and frontal sinus (FS) in sex estimation among Brazilian adults using multislice computed tomography (MCT) and to develop and cross-validate a new formula for sex estimation. METHODS: The present cross-sectional research was conducted in two phases: (1) development of a formula on the basis of the measurements of both the sinuses (50 males and 50 females); and (2) validation study (20 males and 20 females). The linear measurements (height, width and diameter) were assessed using the RadiAnt DICOM software. A new formula for sex estimation was developed (multivariate statistical approach) and validated. Receiver operating characteristic curves, area under the curve, sensitivity, specificity, positive and negative predictive values, accuracy and likelihood ratio were estimated. RESULTS: Males displayed higher mean values (width, height and diameter) of the FS and MS (p < 0.05). The MS was a better predictor in sex estimation (males vs females), compared to the FS (accuracy between 61-74% and 58-69%, respectively). The distance between the right and left MS displayed the highest accuracy (74%). The sensitivity, specificity and accuracy of the new formula were 80%, 95.5% and 87.5%, respectively. 63.1% reduction was observed in the number of predictive values for sex estimation (individuals older than 30 years). CONCLUSIONS: The present MCT measurements showed a higher accuracy in the estimation of sex in males. The highest accuracy was associated with the distance between the right and left MS. The new formula displayed high precision for sex estimation.

Prevalence of malignant neoplastic oral lesions among children and adolescents: A systematic review and meta-analysis.

BACKGROUND: Malignant neoplasms that affect children and adolescents are predominantly embryonic and generally affect blood system cells and supporting tissues. AIM: This study aimed to summarize the scientific evidence about the prevalence of malignant lesions in the oral cavity of children and adolescents. DESIGN: In this systematic review and meta-analysis (PROSPERO CRD42020158338), data were obtained from seven databases and the gray literature. Cross-sectional observational studies on the prevalence of biopsied oral pediatric malignancies were included. The Newcastle-Ottawa Scale assessed the quality of the included studies, and the GRADE approach evaluated the evidence certainty. The meta-analysis prevalence was calculated using MedCalc® software, adopting a 95% confidence level (CI; random-effect model). RESULTS: Forty-two studies were included in the meta-analysis. Of the 64,522 biopsies, the prevalence of malignant lesions was 1.93% (n = 1,100; 95% CI = 1.21%-2.80%). Countries with a low socioeconomic profile showed the highest prevalence. The sample size did not influence the prevalence of oral malignancies, and unspecified lymphomas (12.08%; 95% CI = 5.73%-20.37%) and rhabdomyosarcoma (10.53%; 95% CI = 7.28%-14.30%) were the most common lesions. CONCLUSIONS: Oral malignant lesions biopsied in children and adolescents had a prevalence of <3%, and lymphomas and sarcomas were the most prevalent lesions.

Defining dysmorphic facial features in congenital Zika syndrome.

Congenital Zika syndrome (CZS) constitutes a recently identified malformation caused by Zika virus infection during pregnancy. Limited data is available to date on the facial dysmorphic features of these patients. This study evaluated the facial dysmorphisms of children with CZS, compared with clinically healthy children, using clinical examination and standardized photographic images. Sixty-three children with CZS (9.70 ± 3.2 months-age), and 31 Controls (8.67 ± 6.2 months-age) joined the study. Seven out of 15 indices differed between groups: midfacial height (MFH)/horizontal facial reference (HFR) (p = .0003), interalar distance/HFR (p = .0027), nasal root depth/MFH (p = .0030), posterior nasal length/MFH (p = .0002), vertical position of the ear/MFH (p <.0001), ear length/MFH (p = .0005), chin height/total facial height (CH/TFH) (p <.0001). A CH/TFH of 0.229 showed 93.9% sensitivity and 80.6% specificity in diagnosing CZS. Children with CZS had broad, short faces, decreased intercanthal distance, short posterior nasal length, prominent nasal root, broad nasal wings, and high-set and long ears. Increased chin height index provided the most accurate diagnostic potential.

RT-qPCR study of COX-1 and -2 genes in oral surgical model comparing single-dose preemptive ibuprofen and etoricoxib: A randomized clinical trialy.

BACKGROUND: This study aimed to evaluate the gene expression of cyclooxygenases (COXs) in an oral model of preemptive analgesia. MATERIAL AND METHODS: Gingival tissue was collected during extraction of lower third molars from a randomized, triple-blind, split-mouth and placebo-controlled study. The eligible patients were randomly sorted to receive a single dose either of ibuprofen 400mg, or etoricoxib 120 mg or a placebo, one hour prior to surgery. The temporal course of RNAm was evaluated for COX-1 and -2 by means of a quantitative polymerase chain reaction in real time (RT-qPCR) at time zero and 30 minutes after the surgical procedure began, and it was correlated with clinical parameters (pain and maximum mouth opening). RESULTS: There was a significant increase in COX-1 expression between T0 and T30 in ibuprofen (p=0.004) and etoricoxib (p=0.010) groups. As regards COX-2, there were increases from T0 to T30 in all groups (placebo, p=0.012; ibuprofen, p<0.001; etoricoxib, p<0.001). All groups showed a significant decrease in COX-2:COX-1 ratio from T0 to T30 (placebo, p=0.013; ibuprofen, p<0.001; etoricoxib, p=0.047). Experimental groups showed a significant correlation between COX-1 and COX-2 levels and clinical pain parameters. CONCLUSIONS: The present preemptive analgesia study concludes that COX-2 RNAm induction was directly linked to third molar-related tissue inflammation and that the relation between COX-1 and COX-2 levels were inversely proportional to the preemptively administered nonsteroidal anti-inflammatory drugs COX-2 selectivity. Key words:Preemptive analgesia, dental extraction, cyclooxygenases, real-time polymerase chain reaction.

Clinical, Imaging, and Therapeutic Aspects of Genial Tubercle Fractures: A Systematic Review.

PURPOSE: The present study reviewed the clinical, imaging, and therapeutic aspects of genial tubercle fracture (GTF). MATERIALS AND METHODS: A 2-phase systematic search of the literature was performed. Search strategies were developed for specific databases (PubMed, Scopus, Web of Science, Cochrane, and LILACS), including the gray literature (Open Grey and Google Scholar). The descriptors "genial tubercle," "fractures, bone," "mentalis," "spinae," and "mandible" were searched without restriction to year of publication. The CARE guideline was applied to evaluate methodologic aspects, and the Meta-Analysis of Assessment and Review Instrument was used to assess the risk of bias. The adopted level of significance was .05. RESULTS: Of 1,970 articles, 1,948 were excluded after applying the eligibility criteria. Furthermore, 2 studies were added through a manual search of the reference lists, totaling 24 articles. Occurrence of GTF was most common in women older than 61 years and men younger than 60 years (difference in age at occurrence was statistically significant; P = .019). The main clinical findings were edentulism, sublingual edema, and pain (P < .001). Previous trauma was commonly absent in women and present in men (P = .018). A cracking sound was mainly reported by women (P = .009). Isolated panoramic and occlusal radiographs were the most commonly performed examinations (P < .001). Diagnosis of sialolithiasis occurred in 37.5% of cases, and conservative treatment was performed in 76.6% of cases. CONCLUSION: GTF was mainly observed in older women, edentulous patients, and those without previous trauma. Conventional radiography and nonsurgical treatment were frequently reported.

Does surgically assisted rapid maxillary expansion associated with pterygomaxillary disjunction result in changes in mandibular position? A PROSPERO-compliant systematic review of the literature.

PURPOSE: This study aimed to assess the effect of surgically assisted rapid maxillary expansion (SARME) associated with pterygomaxillary disjunction (PD) on mandibular positioning. MATERIALS AND METHODS: A two-phase systematic review registered with the PROSPERO database was performed. Search strategies were developed for specific databases (PubMed, Scopus, Web of Science, COCHRANE, LILACS, and DOSS), including the gray literature (Open Gray, Google Scholar, and ProQuest). The methodological and evidential quality of the included studies were assessed. RESULTS: Among 680 studies, four were selected for inclusion. In general, a low risk of bias was observed. The studies included a total of 142 adults, and used imaging to perform linear measurements (preoperatively and postoperatively). The main outcomes were maxillomandibular transverse index (difference between effective mandibular width - distance between the left and right antagonist points - and maxillary width), sagittal (forward and backward) and vertical (impaction and extrusion) changes, dental show, chin projection, and altered mandibular position. CONCLUSION: Although the study demonstrated some mandibular position changes after SARME associated with PD, there is insufficient current evidence to support this result because of the potential study limitations related to the number of investigations chosen for inclusion. Further research is required to validate this finding.

Imaging Aspects of the Mandibular Incisive Canal: A PROSPERO-Registered Systematic Review and Meta-Analysis of Cone Beam Computed Tomography Studies

PURPOSE: This study aimed to perform a systematic review and meta-analysis of the literature on the mandibular incisive canal (MIC) studies using cone beam computed tomography (CBCT). MATERIALS AND METHODS: A PROSPERO-registered systematic review (#42017056619) was conducted following the PRISMA statements to summarize current knowledge on the CBCT aspects of the MIC. A search was performed in PubMed's Medline and Scopus databases, without date or language restrictions, using the algorithm {[(Interforaminal region) OR (mandibular incisive channel) OR (mandibular incisive nerve) OR (mental mandible) OR (anterior mandible) (cone beam computed tomography). Also, the references were crosschecked. The Meta-Analysis of Statistics Assessment and Review Instrument and meta-analysis was used to evaluate the selected studies. RESULTS: A total of 410 articles were found, and 25 studies were selected after a two-step selection process. The CBCT systems differed regarding field of view (FOV) (large, n = 3; medium, n = 2; small, n = 4; not informed, n = 16) and voxel size (0.15 to 0.4 mm). Geographically, the studies were distributed across four continents (South America, North America, Asia, and Europe), and there was a statistical significance of studies from the American and Asian continents (P < .0001). From 3,421 CBCT exams, the number of female patients was slightly higher than male, and the mean age ranged from 29.8 to 59.1 years. The overall mean prevalence of MIC was 89.6% ± 15.08%, and bilateral occurrence was statistically significant (P < .0001). The studies using a voxel size lower than 0.3 mm showed the highest mean prevalence (93.88%) in comparison with voxel size described as ≥ 0.3 mm (89.33%). Diameter (0.45 to 4.12 mm) and length (6.6 to 40.3 mm) showed great variability among the included studies. CONCLUSION: In summary, the results of this systematic review evidenced a high worldwide prevalence of MIC. There was no prevalence of MIC in relation to sex, and its presence was mainly related to adults between the fourth and sixth decades of life. In addition, great heterogeneity of methodologies was observed.

Preemptive analgesia-related gene and protein expression in third molar surgeries under non steroidal anti-inflammatory drug protocols: A PROSPERO-registered systematic review of clinical studies

BACKGROUND: This study aimed to review translational studies focusing on third molar removal surgeries through a systematic analytical approach. MATERIAL AND METHODS: A PROSPERO-registered systematic review (CRD42017060455) was conducted following the PRISMA statement to summarize current knowledge on gene expression in third molar surgeries. A search was performed in PubMed's Medline and Scopus databases, without date or language restrictions, using the logical expression {[(Third molar) OR (preemptive) OR (cyclooxygenase inhibitors) OR (acute inflammation) AND (gene expression)]}. RESULTS: All studies included in the analysis evaluated gene expression in a third molar extraction model, using the preemptive analgesia methodology in seven investigations. The sample analyzed was obtained from gingival tissue biopsy (n=4), blood (n=1), transudate (n=1) and gingival tissue biopsy/transudate (n=1). There were differences with respect to evaluated genes, drug protocol, sample studied, and method for evaluating gene expression. CONCLUSIONS: Third molar surgeries were found to be associated with different COX-related gene expression patterns. Although inflammatory events following the surgical procedure are associated with COX isoforms, data from preemptive analgesia studies are scarce, especially from studies correlating gene expression and clinical parameters. In the future, from a clinical perspective, identifying the molecular targets of a drug based on individual gene expression may be helpful to delineate specific third molar, surgery-related, preemptive analgesia protocols

Lesión bucal relacionada con relleno dérmico / Dermal filler-related oral lesion

Introduction: Oral adverse reactions related to natural dermal fillers may originate from infiltration techniques, giving rise to swellings, nodule formation doe to local material entrapment, or displacement or migration of the material used. Objective: describe a case of orofacial foreign body reaction in an elderly patient. Case report: a 65-year-old woman was referred for oral evaluation complaining of an intraoral lesion present for 15 days. Intraoral examination revealed a mobile nodule in the lower lip left portion. After the initial consultation, incisional biopsy was performed under local anesthesia and the surgical specimen was sent for histopathological analysis. Intraoral examination revealed a soft mobile nodule in the lower lip left portion. Clinical pathological and Raman microspectroscopy analysis led to a final diagnosis of calcium hydroxyapatite dermal filler-related reaction. Conclusions: this case reinforces the possibility of dermal filler-related mucosal tissue reactions in oral cavity soft tissues(AU)

Introducción: las reacciones adversas bucales relacionadas con rellenos dérmicos naturales pueden originarse a partir de técnicas de infiltración, lo que ocasiona inflamaciones, formación de nódulos por atrapamiento de material local o desplazamiento o migración del material usado. Objetivo: describir un caso de reacción a cuerpo extraño bucofacial en un adulto mayor. Presentación del caso: una mujer de 65 años de edad fue remitida para evaluación bucal por presentar una lesión intrabucal durante 15 días. El examen intrabucal reveló un nódulo móvil en la porción izquierda del labio inferior. Después de la consulta inicial, se realizó una biopsia incisional bajo anestesia local y se envió la muestra quirúrgica para su análisis histopatológico. El examen intrabucal reveló un nódulo móvil suave en la porción izquierda del labio inferior. El análisis clínico-patológico y de la micro-espectroscopia de Raman condujeron a un diagnóstico final de reacción de hidroxiapatita cálcica relacionada con el relleno dérmico. Conclusiones: este caso refuerza la posibilidad de reacciones cutáneas relacionadas con los rellenos dérmicos en los tejidos mucosos de la cavidad bucal(AU)

Lesión bucal relacionada con relleno dérmico / Dermal filler-related oral lesion

Introduction: Oral adverse reactions related to natural dermal fillers may originate from infiltration techniques, giving rise to swellings, nodule formation doe to local material entrapment, or displacement or migration of the material used. Objective: describe a case of orofacial foreign body reaction in an elderly patient. Case report: a 65-year-old woman was referred for oral evaluation complaining of an intraoral lesion present for 15 days. Intraoral examination revealed a mobile nodule in the lower lip left portion. After the initial consultation, incisional biopsy was performed under local anesthesia and the surgical specimen was sent for histopathological analysis. Intraoral examination revealed a soft mobile nodule in the lower lip left portion. Clinical pathological and Raman microspectroscopy analysis led to a final diagnosis of calcium hydroxyapatite dermal filler-related reaction. Conclusions: this case reinforces the possibility of dermal filler-related mucosal tissue reactions in oral cavity soft tissues(AU)

Introducción: las reacciones adversas bucales relacionadas con rellenos dérmicos naturales pueden originarse a partir de técnicas de infiltración, lo que ocasiona inflamaciones, formación de nódulos por atrapamiento de material local o desplazamiento o migración del material usado. Objetivo: describir un caso de reacción a cuerpo extraño bucofacial en un adulto mayor. Presentación del caso: una mujer de 65 años de edad fue remitida para evaluación bucal por presentar una lesión intrabucal durante 15 días. El examen intrabucal reveló un nódulo móvil en la porción izquierda del labio inferior. Después de la consulta inicial, se realizó una biopsia incisional bajo anestesia local y se envió la muestra quirúrgica para su análisis histopatológico. El examen intrabucal reveló un nódulo móvil suave en la porción izquierda del labio inferior. El análisis clínico-patológico y de la micro-espectroscopia de Raman condujeron a un diagnóstico final de reacción de hidroxiapatita cálcica relacionada con el relleno dérmico. Conclusiones: este caso refuerza la posibilidad de reacciones cutáneas relacionadas con los rellenos dérmicos en los tejidos mucosos de la cavidad bucal(AU)

Perfil Epidemiológico de 23 casos de neoplasias malignas da cavidade oral atendidos em uma instituição odontológica de nível secundário / Epidemiological profile of 23 cases of malignant neoplasm of the oral cavity treated in a secondary dentistry institution

Introdução: O Câncer Bucal representa atualmente um dosgraves problemas de saúde pública no Brasil. Conforme dados doInstituto Nacional do Câncer (INCA), para o ano de 2012, estimase14.170 novos casos. Objetivo: Avaliar o perfil epidemiológicode 23 pacientes portadores de neoplasias malignas atendidos emuma instituição odontológica de atenção secundária no períodoentre maio de 2007 e setembro de 2009. Método: Prontuáriosde 23 pacientes com resultado histopatológico de lesão malignada cavidade oral foral revisados. Gênero, idade, sítio anatômicoe associação com tabagismo e etilismo foram avaliados.Resultados: O carcinoma espinocelular foi o mais prevalente,correspondendo a 87% dos casos. Houve maior prevalência nogênero masculino (60,9%) e na faixa etária entre 50 e 60 anos.Os sítios anatômicos mais acometidos foram língua (34,8%) eassoalho bucal (21,7%). Verificou-se uma associação entre aocorrência das lesões malignas e o hábito de tabagismo umavez que, do total de pacientes acometidos, 47,8% eram fumantese 43,5% eram ex-fumantes. O perfil epidemiológico encontradocondiz com os achados de estudos anteriormente realizados.Conclusões: A caracterização dos casos de câncer bucalpermite definir o perfil epidemiológico dos pacientes acometidose possivelmente represente grande contribuição para oestabelecimento de políticas preventivas relacionadas à doença.

Ránulas intraorales en una población brasileña: estudio retrospectivo del empleo de la marsupialización modificada / Intraoral ranulas in a brazilian population: a retrospective study of the use of modified marsupialization

Las ránulas son seudoquistes resultantes de la extravasación salival de las glándulas sublinguales. Diversos tratamientos han sido empleados, no obstante, la marsupializaión se ha demostrado es el método más utilizado. La modificación de la técnica convencional, haciendo un taponamiento con gasas medicadas, presenta bajos índices de recurrencia, mientras su aplicación cuidadosa. El objetivo de este trabajo fue evaluar los resultados obtenidos por el empleo de la técnica de marsupialización modificada en los casos de ránulas intraorales diagnosticadas en el Servicio de Estomatología de la Facultad de Odontología de la Universidade Federal do Ceará, entre marzo de 1999 a diciembre de 2010, y comparar estos datos con estudios previamente reportados en la literatura. Los datos, tras su colecta, fueron tabulados y analizados estadísticamente (SPSS, versión 17.0). Del total de 2.103 biopsias, 17 (0.8%) correspondieron a ránulas intraorales, con edad comprendida entre 10 y 34 años de edad (media de 22,9 años), siendo 82,4 mujeres y 17,6 hombres. El tamaño de las lesiones varió entre 0,3 y 4 cm, con un promedio de aproximadamente 1,8 cm. La técnica de marsupialización modificada empleada en 13 pacientes, presentó un solo caso de recidiva. Otras dos recurrencias fueron observadas cuando se utilizó la técnica de la extirpación de la lesión, usada en cuatro casos. Nuestros resultados mostraron que la marsupialización, con cambio de la técnica convencional, es un método conservador eficaz, aunque no estadísticamente significativo (p>0,05), debiendo ser elegido como primera opción en el tratamiento de ránulas intraorales, con tasas reducidas de recurrencia.

Ranulas are pseudocysts as a result of salivary extravasation of the sublingual glands. Various treatments have been used, however, has been shown marsupialization the most used. The modification of the conventional technique, carefully filling of the lesion with gauze soaked in nitrofurazone (Furacin ®), have low rates of recurrence. The aim of this study was to evaluate the results obtained using the technique of marsupialization modified in the treatment of intraoral ranulas diagnosed in the Service of Stomatology, Faculty of Dentistry at the Universidade Federal do Ceará, from March 1999 to December 2010, and compare these data with previously reported studies in the literature. The data, after collection, were tabulated and statistically analyzed (SPSS, version 17.0). Of the total of 2,103 biopsies, 17 (0.8%) were intraoral ranulas, aged between 10 and 34 years of age (mean 22.9 years), with 82.4 men and 17.6 women. The lesion size ranged from 0.3 to 4 cm, with an average of about 1.8 cm. Modified marsupialization technique used in 13 patients, presented a single case of recurrence. Two other recurrences were observed when using the technique of surgical excision, used in four cases. Our results showed that marsupialization, with change of the conventional technique is an effective conservative approach, although not statistically significant (p> 0.05), must be chosen as first choice in the treatment of intraoral ranulas, with reduced rates of recurrence.

Adenoid cystic carcinoma of the tongue: Case report and literature review

Adenoid cystic carcinoma is a common malignant neoplasm originated from salivary glands. The clinical and pathological findings typical of this tumor include slow growth, perineural invasion, and potential local recurrence. It accounts for nearly 2% to 4% of head and neck area tumors. In minor salivary glands it usually affects the palate. We described herein the case of a patient who presented a posterior tongue lesion, which was treated with surgery and radiotherapy as additional treatment. We also carried out a brief literature review on the subject