Análise da imunoexpressão da esclerostina em lesões fibro-ósseas dos maxilares

Sclerostin, a product of the SOST gene, acts as a negative regulator of bone formation, primarily because of its properties of inhibition of some signaling pathways related to bone remodeling. The sclerostin is mainly secreted by osteocytes, but also, by other cell populations. The aim of the study was to assess the sclerostin expression in Benign Fibro‑Osseous Lesions (BFOL) of the jaws. A retrospective, transversal, unicenter study selected the cases diagnosed as BFOL. The selected cases were retrieved, and the paraffin blocks were assessed for histological slides to be submitted for a) histochemistry by Hematoxylin and Eosin stain; b) immunohistochemistry for sclerostin expression. For the control group, 6 cases of normal bone harvested from healthy individuals were selected. A total of 66 histological slides from 40 biopsies of 32 patients were analyzed, 20 lesions in females (62.5%) and 12 lesions (37.5%) in male individuals. Eighteen cases were classified as BFOL based only on the anatomical analysis, and the other cases were classified by both clinical and pathological diagnosis, as follows: 06 cases of Fibrous Dysplasia; 4 cases of Juvenile trabecular ossifying fibroma; 2 cases of Psammomatoid ossifying fibroma; and 2 cases of Cemento-osseous dysplasia. There was a positive sclerostin expression in 21 biopsies (52.5%). The marked cells were more present in the fibrous tissue than in the bone. In the cases with positivity in the osteocytes, only 2 were revealed to be in the intralesional bone, and in the other cases, the positivity was found to be in the osteocytes within the perilesional bone. At the fibrous component, marked cells revealed a phenotype similar to the mast cells, and the sclerostin-positive cells were majorly close to the vascular spaces. In the control group, it was found that sclerostin was expressed in cells both at the medullary spaces and in a few osteocytes. In conclusion, Benign Fibro‑Osseous Lesions can express sclerostin, and this expression is mostly concentrated in the fibrous tissue, in mast cell-like cells. In addition, sclerostin is also expressed in the intralesional bone in some specific cases, and on the lesion-surrounding bone.A esclerostina, uma proteína codificada pelo gene SOST, atua como um regulador negativo da formação óssea, uma vez que antagoniza algumas vias de sinalização, dentre elas algumas relacionadas à remodelação óssea. É uma proteína expressa principalmente pelos osteócitos, e também por outras populações celulares. O objetivo do estudo foi avaliar a expressão da esclerostina em lesões fibro-ósseas benignas (LFOBs) dos maxilares. Foi realizado um estudo retrospectivo, transversal, unicêntrico, com o levantamento de casos diagnosticados como LFOBs. Os casos selecionados foram separados, e os blocos de parafina foram acessados para confecção de lâminas histológicas para ambas as técnicas de: a) histoquímica, pela coloração em Hematoxilina e Eosina; b) imunohistoquímica, para avaliar a expressão da esclerostina. Foram também utilizadas 6 amostras de osso normal, advindas de indivíduos saudáveis, para o grupo controle. Foram analisados 66 cortes histológicos provenientes de 40 biópsias realizadas em 32 pacientes, sendo 20 lesões em mulheres (62,5%) e 12 lesões em homens (37,5%). Um total de 18 casos de LFOBs foram avaliados considerando o laudo de anatomia-patológica, já os casos que foram classificados com o laudo e o diagnóstico clínico, foram: 6 casos de displasia fibrosa; 4 casos de fibroma ossificante trabecular juvenil; 2 casos de fibroma ossificante psamomatóide; e 2 casos de displasia cemento-óssea. Houve expressão positiva para esclerostina em 21 biópsias (52,5%). Houve mais marcação no tecido fibroso do que no componente ósseo, e nos casos de marcação em células ósseas, apenas duas biópsias mostraram positividade no osso lesional, sendo os demais com marcação positiva no osso perilesional. No componente fibroso, as células marcadas tinham um fenótipo semelhante aos mastócitos, e as células positivas estavam frequentemente próximas aos espaços vasculares. No grupo controle, encontrou-se marcação positiva em algumas células nos espaços medulares e em poucos osteócitos. Conclui-se que as lesões fibro-ósseas benignas dos maxilares podem expressar esclerostina, e essa expressão se dá em maior parte no componente fibroso, em células com morfologia semelhante aos mastócitos. Ainda, a esclerostina também é expressa no componente ósseo em casos pontuais, além também de ser encontrada expressão positiva no osso perilesional em alguns casos

Extraction of an impacted supernumerary mesiodens tooth in a child: a clinical case report

Mesiodens are supernumerary teeth located between the central incisors, close to the midline; Generally, they have a conical shape, can be impacted, and cause aesthetic-functional imbalance of the stomatognathic system. It is essential to emphasize that early diagnosis, through clinical and complementary exams, provides an optimized therapeutic strategy. The aims of the present study were to report a clinical case on strategies used to delimit the surgical opportunity as well as operative procedures performed in the presence of impacted mesiodens in a child patient. An 11-year-old female patient presented to the dental clinic for evaluation of a mesiodens-type supernumerary tooth. During the clinical examination, no areas of swelling were evident that would indicate the presence of the supernumerary. During the complementary examination, carried out using a panoramic x-ray in semi-open occlusion and ConeBeam® computed tomography, a supernumerary tooth of the mesiodens type can be seen impacted between the roots of the permanent maxillary central incisors. The mesiodens had an intimate relationship with the superior cortex of the nasopalatine canal, promoting luminal stenosis and an intimate relationship with the floor of the nasal fossa. Exodontia was chosen as a therapeutic strategy. Management strategies were reinforced until the surgical procedure session. The patient and legal guardian received post-operative guidance, were monitored for 15 days after the procedure, and were informed of the importance of monitoring until complete rhizogenesis of the permanent maxillary central incisors. In conclusion, it is highlighted that the surgical opportunity needs to be well-defined

Management of the epileptic patient in the dental office: a clinical case report and brief literature review

Outpatient care of epileptic patients can be a significant challenge for dental professionals. Therefore, the present study aimed to report, through a clinical case report, the management of epileptic patients in the dental office. A 16-year-old male patient attended dental care due to tooth decay and periodontal disease. The patient routinely used 250 mg of sodium valproate once a day to control epilepsy. During the clinical and radiographic examination, it was observed the need for guidance regarding dental caries, periodontal disease, suitability of the environment, periodontal, endodontic, surgical, and restorative treatment. Care was taken regarding stress control and, the use of local anesthetics and antibiotics. Given this clinical case report, it was possible to review and act in an optimized manner in the management of epileptic patients in the dental office. The complexity of the disease, the prevalence of those affected, and compromised oral health are highlighted. Dental surgeons must be desensitized to this issue and significantly accommodate this demand from the population

Sialolitíase ductal da glândula submandibular contendo cálculos gigantes: relato de dois casos

Introduction: The presence of calculi in Salivary Glands is considered a quite common phenomenon, however, some of these sialoliths could reach bigger sizes, and then be considered as giant calculus. Objective: The aim of the study was to report two cases of giant calculi in the submandibular salivary gland, also, to improve their analysis by means of their surface area measurement. Case Report: Two adult patients were diagnosed with signs and symptoms suggestive of sialolithiasis. Imaging exams were conducted, with the final diagnosis of Salivary Gland Calculi. Both calculi were surgically removed, under local anesthesia at the dentist’s office. The giant calculi were photographed, measured, and classified as giant calculi because both showed more than 15 mm in the highest axis, also, by heaving a significant surface area. Both cases resolved after surgery, with no history of recurrence. Conclusion: Giant sialoliths are uncommon. It is necessary to discuss this phenomenon aiming for a consensus among the scientific community regarding the classification of the salivary gland calculi. The two cases reported in this article exemplify the complimentary use of the calculation of the calculi surface area on clinical images, which should be considered as an adjuvant maneuver in the classification of salivary sialoliths.Introdução: A presença de cálculos relacionados às glândulas salivares maiores é relativamente comum, no entanto, alguns destes sialólitos podem aumentar consideravelmente de tamanho e serem categorizados como cálculos gigantes. Objetivo: O objetivo deste estudo é relatar dois casos clínicos de sialólitos gigantes em glândula submandibular e complementar a análise por meio da mensuração de área destes cálculos. Relato de Caso: Dois pacientes adultos apresentaram sinais e sintomas sugestivos de sialolitíase. Foram realizados exames de imagem complementares que permitiram delinear o diagnóstico clínico. Foram realizadas abordagens cirúrgicas para tratamento dos sialólitos gigantes, sob anestesia local e em ambiente ambulatorial. Os cálculos foram fotografados, medidos e classificados como gigantes por terem a maior medida de extensão que 15 mm, e por terem uma área total expressiva. Os dois casos tiveram resolução satisfatória, sem história de recidiva. Conclusão: Os sialólitos gigantes são achados incomuns. Faz-se necessário um consenso na comunidade científica quanto a classificação dos cálculos salivares quanto ao seu tamanho para fins de categorização. Os dois casos aqui relatados exemplificam bem o uso do cálculo da área total de superfície dos sialólitos como manobra complementar na classificação de cálculos gigantes