Effect of ELVAX polymer subgingival implants with echistatin on extracted and reimplanted rats' teeth.

To investigate the effect of ELVAX polymer subgingival implants incorporated with echistatin peptide on incisor reimplanted tooth in rats. Forty-two male Wistars rats were divided into two groups: echistatin-treated rats (E) and control rats (C). The animals had their right maxillary incisors extracted and treated according to the International Association of Dental Traumatology replantation protocol. The extra-alveolar dry period was 30 and 60 min, and the post-surgical experimental periods were 15, 60, and 90 days. The samples were stained with H&E and analyzed for the presence of an inflammatory response, incidence of resorptions, and dental ankylosis. Results were statistically analyzed (p < 0.05). The presence of inflammatory resorption was significantly higher in group C at 30 and 60 min extra-alveolar time, in the 15-day postoperative period as compared with the E group (p < 0.05). Dental ankylosis was significantly more prevalent in group E in 30 min extra-alveolar time and 15 days postoperative period (p < 0.05). However, in 60 min extra-alveolar time and 60 days postoperative period, dental ankylosis was more prevalent in C group (p < 0.05). The use of ELVAX subgingival implants with echistatin demonstrated therapeutic potential in preventing the experimental resorption process after replantation of maxillary incisors in rats.

Multiple oral sinus tract and trismus leading to a surprising diagnosis of osteopetrosis: Case report.

AIMS: We report a rare case of late diagnosis of malignant osteopetrosis in a 36-year-old male patient due to multiple intraoral sinus tracts and trismus. CASE REPORT: The patient reported a history of facial scars that could not be attributed to the older external fistulas that were present and various complicated dental extractions since infancy. In addition, the patient had not been previously diagnosed with any other significant diseases other than blindness since infancy. Computed tomography revealed a marble-like sclerotic pattern of all cranial bones, a thickened parietal bone, and a narrowing of the encephalic space and the optic canal. Further laboratory and imaging studies revealed complete sclerosed bone of the chest and pelvis, anemia, reticulocitosis, extramedular hematopoiesis, altered dehydrogenasis lactate, and acid phosphatasis. An interdisciplinary treatment was initiated with medical and dental care monitoring. The patient is still receiving attention after 4 years of follow-up. CONCLUSIONS: The outcome of this case represents the daily challenges faced by interdisciplinary care providers and reveals pearls and pitfalls that can serve as a reference for professional practice in such cases.

Comparative evaluation of vegetable matter involved lesions with oral parasitic infections in the oral cavity.

The current research aims to perform a comparative evaluation of vegetable matter involved lesions with oral parasitic infections found in oral mucosa, presenting histochemical methods to differentiate their microscopic similarities. Eight cases were selected out of a sample of 1.975 reports from a single Oral and Maxillofacial Pathology Service of the author's institution from 2012 to 2019. Specimens were examined by hematoxylin and eosin staining (HE), periodic acid-Schiff (PAS) staining, Gomori-Grocott staining, Ziehl-Neelsen staining, Giemsa, and mucicarmine staining. Microscopic analysis included fluorescence, polarized light, and confocal microscopy. Microscopically, in HE coloration, hookworm eggs showed as eosinophilic. Inflammatory multinucleated giant cells and lymphocytes, were usually related to the nematode eggs, forming an intense inflammatory infiltrate. Biofluorescent properties of eggs and larvae revealed to be sensitive in the detection of parasitic structures contrasting with the inflamed connective tissue. Vegetable presence was confirmed by polarized light microscopy and it was found to be associated with microbial biofilms. Confocal microscopy has showed to be an excellent method for morphotype differentiation of parasitic eggs. Parasitic infection and vegetable matter displayed similarities in the inflammatory response, but the latter can rot and agglomerate biofilms. The microscopic diagnosis of such infections requires the interpretation of challenging morphological features since the parasites are usually sectioned and mixed with an inflammatory reaction. These histochemical approaches proved to be excellent to distinguish both lesions.

Accuracy of radiographic pixel linear analysis in detecting bone loss in periodontal disease: Study in diabetic rats.

INTRODUCTION: Periodontitis, a complex infectious disease that may lead to irreversible loss of periodontium, is considered a predisposing agent for developing insulin resistance due to the release of inflammatory mediators, showing a bilateral relationship with diabetes mellitus. The investigation of periodontal disease requires a clinical approach and complete intraoral radiographs, even with increasing concerns about radiation exposure. Thus, this study assesses pixel linear analysis accuracy using digital radiography via Digora® in detecting alveolar bone destruction in diabetic rats with periodontal disease. METHODOLOGY: 40 rats were divided into groups (n = 10): control (C), rats with periodontal disease (PD), experimental diabetic rats (ED), experimental diabetic rats with periodontal disease (ED-PD). Diabetes was induced by streptozotocin and periodontal disease by periodontal ligature. After 30 days, maxillae bone destruction was obtained by linear analysis of vertical bone loss using digital radiography and then assessed by micro-CT and histology. Data were analyzed by ANOVA and Tukey's test (p < 0.05). RESULTS: Radiographic, micro-CT and histological analysis presented accurate and similar results. PD and ED-PD groups showed higher bone destruction than C and ED groups (p < 0.05). Moreover, the ED-PD group had higher bone loss than the PD group (p < 0.05). CONCLUSION: The pixel linear analysis via digital radiography was an accurate, low-cost alternative in detecting alveolar bone loss in this rat model. Micro-CT and histological analysis may also be used to obtain linear measures to assess and compare periodontal bone destruction in diabetic rats.

Giant sialolith associated with Actinomyces infection, suggesting a new etiopathogenic correlation: a case report.

Sialolithiasis is a disorder of the salivary glands characterized by the presence of mineralized structures. The aim of this article is to contribute to the understanding of the etiopathogenesis of sialolithiasis based on data reported in the literature and the interpretation of scanning electron microscopic (SEM), histopathologic, fluorescence, and energy-dispersive X-ray spectroscopic (EDX) studies. The results of these analyses in a single case are presented. Fluorescence microscopy captured saliva flowing inside a giant sialolith, EDX analysis enabled the quantification of samples of minerals and characterized the chemical composition in the internal areas of the sialolith, and SEM images captured the external communications of the sialolith (ostia). Many theories have been proposed to explain sialolithiasis development, but few consider the role of saliva in its dynamic form. The authors propose that the triple synergism of microbiota, biofilm, and salivary dynamics plays a fundamental role in the development and intrinsic architecture of sialoliths, creating a cyclic sialolithic mineralization. This hypothesis is supported by the results of the laboratory studies in the present case.

Evolution of endodontic medicine: a critical narrative review of the interrelationship between endodontics and systemic pathological conditions.

Endodontics has gained emphasis in the scientific community in recent years due to the increase in clinical and in animal models studies focused on endodontic medicine, which aims to evaluate the interrelationship between systemic and periapical tissues pathological conditions. These studies have shown that systemic changes can boost the pathogenesis of endodontic infection, favoring its development and progression. A contrary relationship is reported in numerous studies that affirm the potential of endodontic infection to trigger systemic damage and may lead to the worsening of pre-existing pathologies. Recently, the potential of filling materials to develop systemic changes such as neurological alterations had been evaluated, also showing that systemic diseases can negatively influence tissue responses to filling materials after endodontic treatment. Despite advances in endodontic medicine studies, there are still gaps in knowledge on the mechanisms of interactions between apical periodontitis (AP) and systemic diseases and much research to be done. In this sense, this critical narrative literature review aimed to show the evolution of studies in endodontic medicine to help the endodontist to know the role of systemic diseases in the pathogenesis of AP and the possible interference in the repair of periapical tissues after endodontic treatment, as well as to evidence the systemic complications that can be triggered or aggravated in the presence of endodontic infection.

Proposal of a minimally invasive approach diagnosing desquamative gingivitis-associated diseases.

BACKGROUND: We aimed to present a minimally invasive clinical approach to collect a suitable sample for the laboratory diagnosis of desquamative gingivitis. MATERIALS AND METHODS: The proposed technique involves Nikolsky's test for the collection of tissue samples. It consists of the histopathological analysis of the bullous membrane formed in cases with positive Nikolsky's sign (NS). Three patients without a previous diagnosis of the disease agreed to undergo this protocol before a biopsy. RESULTS: The diagnoses of the three cases reported here were mucous pemphigoid (MP), pemphigus vulgaris (PV), and lichen planus (LP). The tissue samples collected using this technique were sufficient to microscopically observe partial-thickness epithelium (diagnosing PV) or full-thickness epithelium (diagnosing MP). The diagnosis of LP was only possible by conventional biopsy. CONCLUSION: We observed, for different cases, some advantages of the proposed technique: minimally invasive, potentially superior to exfoliative cytology, easily performed, and with low costs.

Tissue response to white mineral aggregate-based cement containing barium sulfate as alternative radiopacifier: A randomized controlled animal study.

The purpose of this study was to investigate the tissue reaction stimulated by BaSO4 - and Bi2 O3 -containing White MTA Angelus, in comparison with Bi2 O3 -containing white Portland cement, and white ProRoot MTA. Thirty-six adult male Wistar rats (Rattus norvegicus), weighing between 250 and 300 g, were distributed into three groups (n = 12) in accordance with the period of sacrifice (15, 30, and 60 days). Four polyethylene tubes filled with the tested cements were implanted into the dorsum of each rat. Lateral wall of the tubes served as the negative control. After the experimental periods, the animals were euthanized by overdose of pentobarbital anesthetic solution, and the specimens were prepared for microscopic analysis under ×50, ×100, and ×400 magnifications. Inflammatory scores (0-3) were used to grade the tissue reaction. Data were analyzed by the Kruskal-Wallis test and Dunn's test for individual comparisons (p < .05). A mild to moderate inflammatory tissue reaction was observed at the 15-day period, which decreased over the course of the periods for all cements, except for Portland cement. There was no significant difference among the tissue responses for ProRoot MTA, BaSO4 - and Bi2 O3 -containing White MTA Angelus at the 60-day period (p > .05). The Portland group had moderate inflammatory reaction at the final period of analysis, which was statistically different when compared to the other groups (p < .05). The microscopic findings of this animal study suggest that the addition of BaSO4 to White MTA Angelus does not hampers the biocompatibility of the cement.

Low-Level Laser Therapy Approach of Bilateral Necrotizing Sialometaplasia of the Hard and Soft Palates.

Introduction: Necrotizing sialometaplasia (NS) is a rare locally destructive inflammatory benign disease that commonly affects the minor salivary glands. It is frequently associated with the glands located in the posterior portion of the hard and soft palates. Low-level laser therapy (LLLT), also called photobiomodulation therapy (PBMT), has been deemed a substantial method for the regenerative wound process. Case Presentation: A 32-year-old male patient was referred with a chief complaint of two asymptomatic crater-like ulcers measuring approximately 1.5 cm wide on the right side of the hard and soft palates, and another measuring 0.3 cm wide on the left side of the hard palate. The lesion had two weeks of evolution followed by a previous infectious "sore throat" event that kept the patient hospitalized for 4 days. A clinical diagnosis of NS was made. LLLT was applied during 2 sessions per week, favoring the total wound healing within 2 weeks. At 3 months of clinical followup, the patient did not present any complication or relapse and was thus released. Conclusion: This is, to our knowledge, the first clinical report of LLLT applied for the management of NS. Large palatal ulcers caused by NS usually have long healing periods. The shortened healing period observed in this case encourages the inclusion of LLLT in any treatment protocol for similar lesions.

Metastatic Biphasic Primitive Tumor in the Mandible of a Child.

Pediatric mandibular tumors present an aggressive biological behavior and difficult diagnosis. A wide range of odontogenic and nonodontogenic tumors comprise the spectrum of these lesions. We report a case of a 1-year-old male child patient showing facial asymmetry symptomatic of an expansive lesion extending throughout the body and ramus of the left hemimandible with a diameter of 8 cm. The histopathological report suggested a high-grade mucoepidermoid carcinoma (MEC), recommending further immunohistochemical investigation of the ectomesenchymal or neuroectodermal origin of the tumor cells. The patient evolved with extensive bilateral pleural effusion followed by metastasis in the middle third of the right humerus, and died 2 months after the first biopsy procedure by acute renal failure with tubular necrosis, before a final inconclusive immunohistochemical report was reached. The lack of resources for less-favored regions of Brazil impairs rapid biomolecular examinations such as immunohistochemical resulting in delay of appropriate therapeutic procedures.

Histomorphometric comparative analysis between the oral mucosa of fibrous inflammatory hyperplasia and oral leukoplakia.

BACKGROUND: Oral leukoplakia is the most common potentially malignant lesion, the etiology of this change is still uncertain which makes it difficult to predict when this will undergo malignant transformation. Recent studies have examined the involvement of mast cells in this process, it is believed that these cells through the release of pro-angiogenic factors influence the processing mechanism of such lesions through promoting angiogenesis. It was the objective of this study to evaluate the inflammatory process in oral leukoplakia comparing it to a non-cancerous lesion correlating the intensity of mast cells with inflammatory infiltrate and vascularization in these lesions. METHODS: A total of 20 selected cases divided into two groups, oral leukoplakia and inflammatory fibrous hyperplasia (IFH). Histochemical Technique of Toluidine Blue was applied to enhance mast cells and histomorphometry for quantifying mast cells, blood vessels and inflammatory cell infiltration by capturing digital images of the samples and analysis software Image Java version 1.48v. Mast cells and blood vessels were counted in 10 different areas and the intensity of the inflammatory infiltrate was measured in three areas. The analysis of variance (ANOVA) was used for between-group variation, a P value of 0.05 for statistical significance. RESULTS: It was observed a reduction in the concentration of mast cells in oral leukoplakia compared fibrous inflammatory hyperplasia. In contrast to the concentration of blood vessels were present in higher concentrations in the Oral leukoplakia lesions. The inflammatory infiltrate in most cases was considered scarce, except in a case where that IFH was intense and a case of moderate inflammatory infiltrate in oral leukoplakia. CONCLUSIONS: The results showed reduction in the number of mast cells in the oral leukoplakia and greater intensity in the inflammatory process in the IFH, suggesting a possible carcinogenic influence in the microenvironment oral leukoplakia.

Sialadenoma papilliferum: Bibliometric analysis.

BACKGROUND: Sialadenoma papilliferum is a benign rare condition of salivary glands showing a characteristic papillary growth of the ductal epithelium that ends up being confused with more frequent lesions of the oral cavity. Objectives: To perform a bibliometric analysis of all articles about Sialadenoma papilliferum in the oral cavity and to add a singular case report of Sialadenoma in the lower lip. MATERIAL AND METHODS: A total of 36 publications referring to Sialadenoma papilliferum in the oral cavity from the PubMed platform was reviewed. The specific data were collected, and a bibliometric analysis was performed using Microsoft Excel. The results obtained were then compared with this new case report. RESULTS: The people most affected with sialadenoma were white males at the average age of 56. The lesion was asymptomatic, usually white or red, with an average size of 1.4 cm, and the palate was by far the most affected site. The majority of the lesions were excised, and only two cases indicated recurrence. CONCLUSIONS: With surgical removal, Sialadenoma papilliferum has a favorable prognosis and no further treatment is required. Due to few recorded cases of recurrence, a long follow-up period is recommended to ensure that the lesion does not redevelop. Key words:Sialadenoma papilliferum, salivary gland, oral cavity, bibliometric analysis.

Histomorphometric Comparative Analysis between Oral Dysplastic Potentially Malignant Disorders and Oral Squamous Cell Carcinoma.

OBJECTIVE: This study aimed to determine the correlation between the vascular mast cells and inflammatory changes in the potentially malignant disorders, compared to the oral squamous cell carcinoma (OSCC) in varying degrees of dysplasia. MATERIALS AND METHODS: Thirty samples were selected: 10 of OSCC, 10 of oral leukoplakia, and 10 of actinic keratosis. The toluidine blue technique was used on the mast cells, and hematoxylin and eosin were used for analyzing the lymphocytes, mitosis, and vessels. The quantification was performed using the ImageJ software after obtaining the images by light microscopy with a × 40 objective. Analysis of variance with p < 0.05 was considered for statistical significance. RESULTS: Mast cells (p < 0.0158), vessels (p < 0.9431), lymphocytes (p < 0.0001), and mitoses (p < 0.0009) were found in OSCC. In potentially malignant disorders, a lower density of these structures and a higher concentration of mitosis in the actinic keratosis were observed. CONCLUSION: The results showed evidence of a positive correlation between mast cells and vascularization in the OSCC, suggesting the aggression of the disease. Intense inflammatory infiltrate indicates that other molecular events are involved in the carcinogenesis process, and further studies are necessary for a better understanding of it.

Diagnostic sequence for early diagnosis of neurofibromatosis type 1 using NIH criteria.

Early diagnosis of neurofibromatosis is significant to start the multidisciplinary approach of this type of patient. This syndrome may be first identified in pediatric dental care. This study is about a 9-year-old patient who was diagnosed with neurofibromatosis type 1 from a plexiform neurofibroma displayed in the left hemi-maxilla. From the microscopic diagnosis of the lesion the investigation of other related injuries began, according to the diagnostic criteria of the National Institute of Health (NIH), leading to the diagnosis of systemic alterations. The parental awareness about the condition and the establishment of multidisciplinary care are important for the treatment to be more conservative and the patient has fewer complications with better quality of life. The use of the diagnostic criteria in this case shows how methodization is important for reaching more accurate and reliable diagnoses.

A new case of the pilomatrixoma rare in the preauricular region and review of series of cases.

Pilomatrixoma is considered a rare benign tumor arising from the hair follicle, most common in the head and neck region, but it is rarely diagnosed on a clinical basis. This report describes a new case of giant pilomatrixoma in a 36-year-old female patient. The nodule was localized in the preauricular area on the right side, appearing as a slow-growing, fixed, painless, with a hardened consistency, unusual giant (4.5 cm). A cone-beam computed tomography (CBCT) examination showed a slightly hyperdense lesion, and fine-needle aspiration cytology (FNAC) revealed peripheral blood and mononucleated inflammatory cells. After enucleation of lesion, a diagnosis of pilomatrixoma was confirmed. The differential diagnosis of pilomatrixoma is broad, because its characteristics also can be found in other lesions common to the head and neck. Thus, a lesion in the head and neck, adherent to the skin, and well demarcated, mainly in the young and in females, should be suspected as pilomatrixoma.

Diagnosis, treatment, and rehabilitation of a patient with inflammatory pseudotumor.

Inflammatory pseudotumors are a group of lesions of unknown etiology that mimic clinically and radiographically neoplasms. In the maxilla, inflammatory pseudotumors are presented with bone alterations of erosion, remodeling, and sclerosis. The diagnosis is of exclusion, where multiple biopsies are required. The present study aims to report the case of a male patient who presented with increased volume in the left maxillary region, with diagnosis after total left maxillectomy being inflammatory pseudotumor. The patient did not present recurrences with 3 years of preservation and underwent by multidisciplinary treatment with esthetic and functional rehabilitation with the preparation of a bucomaxilo prosthesis. Despite presenting some suggestive clinical features, the inflammatory pseudotumor has a difficult and of exclusion diagnosis, where multiple biopsies are required. They are lesions that simulate clinically and radiographically neoplasms. If it is surgically accessible, the treatment of choice is complete surgical resection.

Palatal perforation and chemical ulcers of the tongue in a blind patient.

We report a unique case of a potassium aluminum sulfate oral dissolution leading to palatal chemical necrosis and extensive chemical ulcers on the tongue. The patient, a 47-year-old white, blind male, denied using cocaine or other illegal drugs that could cause such lesions. His self-medication started as a treatment for a traumatic ulcerative lesion on the hard palate. After palatal perforation, he started another self-medication routine, mixing corticoid cream and tandrilax tablets with a gauze obturator. Our treatment comprised the removal of all chemical factors, a surgical debridement, and a prosthetic obturator to resolve the communication. The 1-year follow-up showed no complications.

Tratamento cirúrgico de mucocele de tamanho atípico em lábio inferior: relato de caso / Surgical treatment of atypical size mucocele in the lower lip: case presentation

Mucocele é uma lesão oral, que ocorre a partir do acúmulo de mucina nos tecidos moles, por retenção ou extravasamento. Este último, o mais comum, ocorre, principalmente, após trauma mecânico, cujo ato resulta em rompimento do ducto da glândula salivar. O presente trabalho tem como objetivo relatar um caso de mucocele de tamanho atípico, em uma paciente de 28 anos. A abordagem clínica do caso, bem como o tratamento serão discutidos... (AU)

Mucocele is an oral injury that occurs from the mucin accumulation in soft tissue for retention or extravasation. The last, the most common, mainly occurs after mechanical trauma act which results in disruption of the salivary gland duct. This study has the purpose to report a case of atypical size of mucocele in a 28-year-old patient. The clinical approach of the case, and the treatment will be discussed... (AU)

The So-called Garrè's Osteomyelitis of Jaws and the Pivotal Utility of Computed Tomography Scan.

The present paper draw the attention of clinicians to investigate multiple slices of the computed tomography (CT) scan looking for a safe diagnosis of the so-called Garrè's osteomyelitis (GO) of jaws, a not uncommon disease characterized by astonishing bone growth. We report a case involving the left mandible of a 12-year-old girl presenting with a bony enlargement at left mandible. Initial examination revealed carious process of tooth 36 with radiographic apical rarefaction. However, we need to take care with this diagnosis because other aggressive diseases may cause bone enlargement mimicking GO. We observed here that careful examination of CT slices must be elucidative. In the present case, we observed the formation of a hypodense channel between periapical disease and the bone growth, through CT, thus supporting the pathophysiologic conditions for GO and allowing a safer decision to make the intervention restricted to tooth.