Odontogenic tumors: clinical and pathology study of 238 cases

SummaryOdontogenic tumors are neoplasms that develops exclusively in the gnathic bones; they originate from odontogenic tissues, by epithelial or mesenchymal proliferation, or both.AimTo evaluate the incidence of odontogenic tumors in a specific institution, and to compare these findings with other studies in the literature.Study formatA cross-sectional cohort retrospective study.Material and methodThe sample was obtained from the files of patients with odontogenic tumors diagnosed between January 1992 and March 2007 (15 years). Cases in which the diagnosis could be adapted to the new World Health Organization (WHO) of 2005 were included. Data such as gender, age, anatomical site, histological type and symptomatology were analyzed.ResultsOdontogenic tumors were 4.76% of all biopsied lesions within the studied period. The mean age was 30.7 years; 57% of the patients were male. The keratocystic odontogenic tumor was the most prevalent histological type (30%), followed by the ameloblastoma (23,7%). The rate of asymptomatic cases was 75.7%.ConclusionOdontogenic tumors occurred more frequently in females, in the second and third decades of life, and more commonly in the mandible; most cases were asymptomatic

Lasertherapy efficacy in temporomandibular disorders: control study

A disfunção têmporo-mandibular é caracterizada pela presença de sintomatologia dolorosa articular/muscular na região da face. A principal justificativa do uso do laser da laserterapia na disfunção é seu efeito analgésico, fato observado na maioria dos estudos encontrados na literatura. OBJETIVO: Foi avaliar a eficácia da laserterapia no tratamento das disfunções têmporo-mandibulares. MATERIAL E MÉTODO: 50 voluntários com disfunção têmporo-mandibular foram divididos em dois grupos (controle e experimental) tiveram as amplitudes dos movimentos de abertura bucal, lateralidade direita e esquerda registrados, antes e após aplicação do laser. Foi registrada, também, a nota de dor do indivíduo através da escala analógica visual de dor e, através do exame físico, os pontos álgicos. Utilizou-se o laser de AsGaAl com potência de 40mW, com 80J/cm², por 16 segundos, em quatro pontos selecionados por apenas uma sessão com reavaliação após uma semana. Desenho Científico Utilizado: Clínico. RESULTADOS: Notou-se que a laserterapia promoveu aumento da média de amplitude dos movimentos mandibulares (p=0,0317) e houve redução significativa (43,6%) da intensidade de dor dos pacientes medida através da escala analógica visual de dor. CONCLUSÕES: A laserterapia promove redução da sintomatologia dolorosa do paciente após a aplicação por ação analgésica e/ou por um efeito placebo.Temporomandibular dysfunction is characterized by the presence of painful joint/muscular symptoms muscle in the face. The main justification for the use of lasers in laser therapy dysfunction is its analgesic effect, which was observed in most studies in the literature. AIM: We evaluated the effectiveness of laser therapy in the treatment of temporomandibular disorders. METHODS: 50 volunteers with temporomandibular disorders were divided into two groups (control and experimental) had amplitudes of movements of mouth opening, right and left laterality recorded before and after laser application. Was also recorded, the score the individual gave to pain by visual analog scale and, through physical examination, the pain points. We used the AsGaAl laser with a 40mW power, with 80J/cm² for 16 seconds at four selected points for just one session with reassessment after a week. Study design: Clinical. RESULTS: It was noted that laser therapy increased the mean amplitude of mandibular movements (p = 0.0317) and decreased significantly (43.6%) the pain intensity measured by the visual analog scale. CONCLUSIONS: The laser decreases the painful symptoms of the patient after application through its analgesic and/or a placebo effect

Fop/Upe´S Graduation Students Knowledge About Local Anaesthetics Indications To Special Patients

Objetivo: verificar e analisar o conhecimento dos alunos de graduação, nas clínicas da Faculdade de Odontologia de Pernambuco, em relação às indicações de anestésicos locais em pacientes especiais. Material e métodos: foi realizado um estudo prospectivo, transversal, aplicando-se questionários aos alunos de graduação do 6º ao 9º períodos da Faculdade de Odontologia de Pernambuco – FOP/UPE, em atendimento nas clínicas da faculdade a fim de verificar e analisar seu conhecimento em relação à dosagem e indicações de anestésico local, nos diversos procedimentos constituintes da prática odontológica.  Resultados: após a análise da amostra total de 176 alunos, verificou-se que quando questionados sobre indicação de sal anestésico de primeira escolha para pacientes diabéticos, asmáticos, com hipertireoidismo e usuários de medicamentos antidepressivos, a resposta “Não sabe” esteve predominante, variando entre 38,1 a 85,2%, sendo um mínimo percentual de acertos para cada um dos grupos de pacientes.  Conclusões: tais resultados denotam falta de preparo por parte dos alunos sobre conhecimentos teóricos e práticos da anestesiologia aplicada à pacientes com necessidades especiais. Uma maior atenção deve ser dada ao tema, dada sua importância e relevância dentro da prática clínica diária do cirurgião dentista.Aim: to verify and analyze the graduation students knowledge, at FOP/UPE’s clinics, related to local anesthetics indications for special patients.     Material and methods: in a transversal prospective study, questionnaires were asked to the FOP/UPE`s 6th to 9th periods graduation students, attending on the college clinics, in order to verify and analyze their answers about local anesthetics dosages and indications, in the dentistry practice main procedures.  Results: after the 176 students data analysis, it was verified that when questioned about local anesthetics indications for patients with diabetes, asthma, hyperthyroidism and antidepressants users, the answer “don´t know” was most prevalent, varying between 38,1 and 85,2%.    Conclusions: such results suggest lack of prepare of the students on theoretical and practical anesthesiology information applied to patients with special conditions. A better attention must be given to the theme, once its importance and relevance on the dentist clinical daily practice

A judicialização de cirurgia bucomaxilofacial e o sistema de assistência à saúde dos servidores públicos de Pernambuco

The Brazilian Federal Constitution of 1988 was a pioneer in providing the right to health as a fundamental right and regulating the supplementary  health system. Several states have  created plans aimed exclusively at their servants, and  Pernambuco was the pioneer to conceive them, through the Health Assistance System of the Servants of the State of Pernambuco. The  technological advances, the increase of life  expectancy (and the consequent early tooth loss) and the traumas have caused an increase in the use of  orthoses, prostheses and special materials in invasive  procedures - providing, among other  benefits, esthetic repair. However, there are obstacles to the use of these materials, including  their high cost and the lack of private health insurance coverage for esthetic procedures. The  judicial proceedings involving orthoses, prostheses and special materials in oral and maxillofacial  surgery against the Health Assistance System of the  Servants of the State of Pernambuco were analyzed,  from January 2009 to December 2017. The purpose was to defend that the indication of the material to  be used by the dental surgeon cannot be considered as an absolute criterion and that the Judiciary should not accept such an opinion without questioning it. It was verified the need to open a larger structure to the magistrates, with the creation of centers for  technical assistance in health and/or investments in the existing one, in order to subsidize the judges and  ensure a greater efficiency in the solution of the  demands.  A CF/88 foi pioneira ao dispor sobre o direito à saúde como direito fundamental e regular o sistema suplementar de saúde. Vários estados brasileiros criaram planos voltados exclusivamente para seus servidores; Pernambuco foi o pioneiro a concebê-los, através do Sistema de Assistência à Saúde dos Servidores do Estado de Pernambuco. Os avanços tecnológicos, o aumento da expectativa de vida (e a consequente perda dentária precoce) e os traumas provocaram aumento do uso de órteses, próteses e materiais especiais em procedimentos invasivos – proporcionando, dentre outros benefícios, a reparação estética. Porém, há entraves ao uso desses materiais, entre eles seu alto custo e a ausência de cobertura dos planos de saúde para procedimentos estéticos. Foram analisados os  processos judiciais envolvendo órteses, próteses e materiais especiais em cirurgia bucomaxilofacial contra o Sistema de Assistência dos  Servidores de Pernambuco, entre janeiro de 2009 e dezembro de 2017. O propósito foi defender que a indicação do material a ser utilizado  pelo cirurgião-dentista não pode ser considerada critério absoluto e que o Poder Judiciário não deve  acatar tal opinião sem questioná-la. Verificou-se a necessidade de franquear maior estrutura aos magistrados, com a criação de núcleos de assistência técnica em saúde e/ou investimentos nos já existentes, a fim de subsidiar os julgadores e assegurar uma maior eficiência na solução das demandas. A metodologia aplicada foi a do estudo transversal, baseado na análise de dados  quantitativos e qualitativos extraídos dos processos. Como variáveis, traçaram-se o perfil dos autores das  ações e os parâmetros adotados nas decisões judiciais.

Prostatic Artery Embolization as a Primary Treatment for Benign Prostatic Hyperplasia: Preliminary Results in Two Patients

Symptomatic benign prostatic hyperplasia (BPH) typically occurs in the sixth and seventh decades, and the most frequent obstructive urinary symptoms are hesitancy, decreased urinary stream, sensation of incomplete emptying, nocturia, frequency, and urgency. Various medications, specifically 5-α-reductase inhibitors and selective α-blockers, can decrease the severity of the symptoms secondary to BPH, but prostatectomy is still considered to be the traditional method of management. We report the preliminary results for two patients with acute urinary retention due to BPH, successfully treated by prostate artery embolization (PAE). The patients were investigated using the International Prostate Symptom Score, by digital rectal examination, urodynamic testing, prostate biopsy, transrectal ultrasound (US), and magnetic resonance imaging (MRI). Uroflowmetry and postvoid residual urine volume complemented the investigation at 30, 90, and 180 days after PAE. The procedure was performed under local anesthesia; embolization of the prostate arteries was performed with a microcatheter and 300- to 500-μm microspheres using complete stasis as the end point. One patient was subjected to bilateral PAE and the other to unilateral PAE; they urinated spontaneously after removal of the urethral catheter, 15 and 10 days after the procedure, respectively. At 6-month follow-up, US and MRI revealed a prostate reduction of 39.7% and 47.8%, respectively, for the bilateral PAE and 25.5 and 27.8%, respectively, for the patient submitted to unilateral PAE. The early results, at 6-month follow-up, for the two patients with BPH show a promising potential alternative for treatment with PAE

Treatment of cervical bone defects with porous osteoconductive materials in immediate implants: a histological, histometric, micro-CT and RFA study in dogs

O objetivo do presente estudo foi comparar a eficácia da implantação de biomateriais porosos na neoformação óssea e reparo de defeitos cervicais mandibulares em cães, com ou sem a técnica de regeneração óssea guiada (ROG). Bio-Oss Block® (BB), Bio-Oss Collagen® (BC), Bio-Oss® em grânulos (BG), osso autógeno (Ab) e coágulo (Cg) foram utilizados nas mesmas situações experimentais. Para o grupo com membrana foi utilizado o BioGide®. Doze cães foram submetidos a extrações dos pré-molares e primeiros molares mandibulares bilateralmente. Quatro meses após cinco defeitos ósseos (6 mm de diâmetro/4 mm de profundidade) foram confeccionados em um lado. Implantes de 3,3 x 10 mm foram instalados na mesial de cada defeito, proporcionando um \"gap\" distal de 2,7 mm. Os defeitos foram aleatoriamente preenchidos com Ab, Cg, BB, BC e BG. Os mesmos procedimentos foram executados no lado oposto após oito semanas. A membrana foi utilizada para recobrir os defeitos em metade dos lados. Os animais foram sacrificados após oito semanas. A estabilidade dos implantes foi aferida pelo Osstell Mentor®, na instalação do implante e no sacrifício. Os espécimes (n=60, sendo 3 de cada grupo) foram escaneados em micro-tomógrafo Skyscan® 1172. Após aquisição das imagens, o volume de interesse de 3,0 x 6,0 x 4,0 mm foi estabelecido e os parâmetros relativos à formação óssea foram avaliados. Todos os biomateriais foram escaneados in vitro para avaliação da porosidade. Utilizando a técnica de cortes por desgaste, lâminas histológicas foram confeccionadas para a avaliação histológica e histométrica de cada espécimen. As análises histométricas revelaram que o BC apresentou formação óssea semelhante ao Ab em 8 semanas sem BGd. O Cg mostrou a maior formação óssea entre os tratamentos testados em 16 semanas com BGd, e foi superior ao BB e BG em 8 semanas sem BGd (p0,05). A análise de superfície óssea mostrou valores aumentados em sítios tratados com BG, seguido por BC em 8 semanas sem BGd, e Ab em 8 semanas com BGd (p0.05). Bone surface area analysis showed that increased values in sites treated with BG, followed by BC without BGd at 8 weeks, and Ab at 8 weeks with BGd (p<0.05). The BC presented greater Bone Surface Area/Bone volume at 8 (with and without BGd) and 16 weeks with BGd (p<0.05). BB had the lowest values at 16 weeks (without BGd). Cg presented the worst performance among treatments at 16 weeks (with BGd) (p<0.05). Regarding the Trabecular Thickness, Ab and BB showed the highest and lowest values, respectively (p<0.05), regardless of the time point or membrane use. In biomaterials porosity analysis, BG showed higher numbers, volume, and surface area of closed pores. BB had the highest volume of open pores, open porosity and total porosity compared with the other treatments. It can be concluded the use of a high porosity block (BB) failed to provide greater bone formation within the defect area and it was the treatment that better reduced distal alveolar crest resorption. Biomaterials with lower porosity (BC and BG) showed higher or similar bone formation and implant stability if compared to autogenous bone. The appliance of BGd improved bone formation in all treatments and tested periods and reduced soft tissue presence within the defect. An inverse relationship between biomaterials\' in vitro porosity and in vivo bone formation was observed in the experimental model used

Early Osseointegration Events on Neoss (R) ProActive and Bimodal Implants : A Comparison of Different Surfaces in an Animal Model

Background: Cell interactions, adherence, and osseointegration at the bone-implant interface can be directly influenced by the surface properties of the titanium implant. Purpose: To characterize osseointegration of Neoss (R) implants with conventional (control group) and hydrophilic (test group) surface treatments. Materials and Methods: Six Labrador dogs received Neoss implants with conventional and hydrophilic surfaces. The bone-implant interfaces were evaluated 1 and 4 weeks after implantation, and osseointegration was evaluated using histological, histomorphometric, fluorescence, and resonance frequency analyses. The surfaces were also subjected to topographic and hydrophilicity analyses. Results: The topographic analyses revealed increased surface roughness in the test group compared with the control group (surface area roughness 0.42 and 0.78 mu m, respectively, for control and test group surfaces; p <= .05). The wettability values were higher in the test group (contact angles 67.2 degrees and 27.2 degrees for the control and test group surfaces, respectively; p <= .05). Implants in the test group also exhibited better stability, more bone-implant contact, and increased bone area compared with implants in the control group. Conclusion: Neoss implants in the test group improved bone formation in the early stages of osseointegration compared with implants in the control group

Immunohistochemical, tomographic, and histological study on onlay bone graft remodeling. Part III: allografts

Objective In the last decades aroused the interest for bone tissue bank as an alternative to autogenous grafting, avoiding donor sites morbidity, surgical time, and costs reduction. The purpose of the study was to compare allografts (ALg) with autografts (AUg) using histology, immunochemistry, and tomographic analysis. Material and methods Fifty-six New Zealand White rabbits were submitted to surgical procedures. Twenty animals were donors and 36 were actually submitted to onlay grafting with ALg (experimental group) and AUg (control group) randomly placed bilaterally in the mandible. Six animals of each group were sacrificed at 3, 5, 7, 10, 20, and 60 postoperative days. Immunolabeling was accomplished with osteoprotegerin (OPG); receptor activator of nuclear factor-k ligand (RANKL); alkaline phosphatase (ALP); osteopontin (OPN); vascular endothelial growth factor (VEGF); tartrate-resistant acid phosphatase (TRAP); collagen type I (COL I); and osteocalcin (OC). Density and volume of the grafts was evaluated on tomography obtained at the surgery and sacrifice. Results The ALg and AUg exhibited similar patterns of density and volume throughout the experiments. The intra-group data showed statistical differences at days 7 and 60 in comparison with other time points (P = 0.001), in both groups. A slight graft expansion from fixation until day 20 (P = 0.532) was observed in the AUg group and then resorbed significantly at the day 60 (P = 0.015). ALg volume remained stable until day 7 and decreased at day 10 (P = 0.045). The light microscopy analysis showed more efficient incorporation of AUg onto the recipient bed if compared with the ALg group. The immunohistochemical labeling picked: at days 10 and 20 with OPG in the AUg group and at day 7 with TRAP in the ALg group (P = 0.001 and P = 0.002, respectively). Conclusions ALg and AUg were not differing in patterns of volume and density during entire experiment. Histological data exhibit more efficient AUg incorporation into recipient bed compared with the ALg group. Immunohistochemistry outcomes demonstrated similar pattern for both ALg and AUg groups, except for an increasing resorption activity in the ALg group mediated by TRAP and in the AUg group by higher OPG labeling. However, this latter observation does not seem to influence clinical outcomes