Osteomielite maxilar associada ao COVID-19: mucormicose ou não? Uma série de casos / Maxillary osteomyelitis associated with COVID-19: mucormycosis or not? A series of cases

Aim: A series of cases have been presented involving the oral cavity focusing on the presentation, diagnosis and treatment of mucormycosis that can form a basis for successful therapy. Background: The management of severe coronavirus disease (COVID-19) in conjunction with comorbidities such as diabetes mellitus, hematological malignancies, organ transplants, and immunosuppression have led to a rise of mucormycosis which is an opportunistic infection. Cases Description: The various forms that have been enlisted till date are rhino-cerebral, rhino-orbital, gastrointestinal, cutaneous, and disseminated mucormycosis. From the dentistry and maxillofacial surgery perspective, the cases depicting extension of mucormycosis into the oral cavity have been less frequently recorded and thus, require a detailed study. The patients that reported to our private practice had non-tender swelling, draining sinuses and mobility of teeth. A similarity was observed in the clinical signs both in osteomyelitis and mucormycosis. Thus, a histopathological examination was used to establish the definitive diagnosis. Conclusion: Mucormycosis is a life threatening pathology that requires intervention by other branches to make an early diagnosis and commence the treatment. The characteristic ulceration or necrosis is often absent in the initial stage and thus, histopathological examination and radiographic assessment are required to formulate a definitive diagnosis. Early intervention is a necessity to avoid morbidity. The treatment involves surgical debridement of the necrotic infected tissue followed by systemic antifungal therapy. Mucormycosis has recently seen a spike in its prevalence, post the second-wave of coronavirus pandemic in India. It was seen commonly in patients with compromised immunity, diabetes mellitus, hematological malignancies, or on corticosteroid therapy. Mucormycosis invading the palate mostly via maxillary sinus has been less frequently described. In the post-COVID era the features associated with mucormycosis involving oral cavity, should warrant a possible differential diagnosis and managed appropriately. (AU)

Objetivo: Apresentar uma série de casos com enfâse na apresentação, diagnóstico e tratamento da mucormicose oral, assim como uma revisão sistemática que sirva como base para estabelecimento de terapias de sucesso. Introdução: A forma severa da infecção por coronavirus (COVID-19) associada a diabetes mellitus, doenças hematológicas malignas, transplante de órgãos e imunossupressão levaram a um aumento das infecções oportunistas de mucormicose. Descrição dos Casos: As diversas apresentações clínicas que foram descritas até o momento são a rinocerebral, rino-orbital, gastrointestinal, cutânea e mucormicose disseminada. No que concerne a odontologia e a cirurgia maxillofacial, os casos que apresentam extensão de mucormicose para cavidade oral tem sido menos reportados e assim requerem mais estudos. Os pacientes que compareceram a nossa clínica apresentavam aumento de volume endurecido, drenagem de fluidos dos seios maxilares e mobilidade dentária. Clinicamente tanto a osteomielite quanto a mucormicose apresentaram-se de forma semelhante. Assim, análise histopatológica foi utilizada para estabelecimento do diagnóstico definitivo. Conclusão: A mucormicose é uma patologia grave que requer intervenção precoce para estabelecimento do tratamento. A ulceração e necrose características usualmente estão ausentes nos estágios iniciais da lesão, assim análise histopatológica e radiográfica são necessárias para o diagnóstico final. Intervenção precoce é necessária para diminuir a morbidade. O tratamento envolve o debridamento cirúrgico da área necrosada seguida de terapia antifúngica sistêmica. Recentemente, houve um aumento nos casos de mucormicose, após a Segunda onda da pandemia de COVID-19 na índia. Os casos acometiam principalmente pacientes imunocomprometidos, com diabetes mellitus, doenças hematológicas malignas e em uso de corticosteróides. A mucormicose invadindo o palato pelos seios maxilares foi raramente descrita. Na era pós-COVID a mucormicose envolvendo a cavidade oral deve entrar no painel de diagnósticos diferenciais para que o tratamento adequado possa ser instituído precocemente.(AU)

Cast-Based Guided Implant Placement and Prosthetic Rehabilitation of a Single Edentulous Space: Case Report and Systematic Analysis of Surgical Guides Used in Implant Dentistry.

This report discusses a clinical case of prosthetic rehabilitation of a single edentulous space using cast-based guided implant placement, a surgical protocol for correct implant installation. It also provides a rundown of various techniques used and surgical guides available in dental implantology. Correct and preplanned implant positioning and angulation are the adjuncts to a successful implant-supported restoration. Initially, the residual bone available and its quality were the sole factors that determined implant position and angulation. Lately, prosthetically driven implant prostheses have ensured good aesthetics, function, and hygiene maintenance resulting in long-term success. A surgical guide provides adequate information regarding implant placement and also provides an aid for implant placement at the time of surgical procedure depending on the type of guide fabricated. Cast-based surgical guide fabrication is precise, economical, and time saving in achieving accurate positioning of the implant and subsequently prosthesis placement for correct functioning.

Surface Treatment and Implant Bone Interface: A Systematic Literature Review.

In the present scenario, dental implants have proven to be a very reliable and popular treatment option for partial and completely edentulous arches. The biological, chemical, local, clinician, and implant related factors determine sequence of bone turnover that eventually enhances the success of implant therapy. The positioning of implant is followed by an inflammatory process that results in de novo bone formation and deposition on the implant surface. Pure titanium is commercially the prime material of choice for an implant. The implant surface can be chemically altered by a change in manufacturing, finishing, thermal treatment, blasting etching, coatings, and even sterilization procedures. These techniques have led to major innovations in implant dentistry as they roughen the surface, promoting bone deposition and stability. The current paper gives a comprehensive review of the diverse topographical characteristics of an implant surface and the altered techniques offered to create appropriate roughness to enhance osseointegration starting from fundamental to the latest techniques.

Orocutaneous Fistula or Traumatic Infectious Skin Lesion: A Diagnostic Dilemma.

Orocutaneous fistula (OCF) (of dental origin) is an uncommon but well-described condition in the literature. These are often misdiagnosed by physicians and dentists. Careful selection of investigating modality is important in case of diagnostically challenging cases. A 19-year-old female came with a complaint of a lesion on the chin reported with h/o trauma with the impact on chin presented as diagnostic dilemma because of unusual case history and clinical examination. Commonly used radiographic investigations like IOPA and orthopantomograph did not resolve the dilemma whereas advanced imaging modality like CT scan, 3D volume imaging, and contrast enhanced CT played an important role in the diagnosis of OCF and selecting the treatment plan.

Maxillary adenomatoid odontogenic tumor associated with a premolar.

The adenomatoid odontogenic tumor (AOT) represents 3-7% of all odontogenic tumors, and over 750 cases have been reported in the literature. This lesion was formerly considered to be a variant of the ameloblastoma and was designated as adenoameloblastoma. These lesions may infrequently produce dentinoid material and rarely enamel matrix. Consequently, the WHO (2005) classification of odontogenic lesions considered this process to represent a mixed odontogenic neoplasm. We present a case of a 12-year-old female patient with an AOT of diameter 5 cm × 5 cm located in the anterolateral region of the maxilla in association with an impacted premolar tooth. The rarity of AOT, association of this lesion with regards to maxillary premolar, the exaggerated size at presentation, the eruption of the displaced canine postoperatively and uneventful healing of the bony defect without adjunctive therapy makes this case unique.