Tumefações do soalho bucal relacionadas às glândulas sublinguais em pacientes edêntulos ou parcialmente edêntulos: estudo microscópico

Mouth floor enlargements (MFE) are observed in edentulous and partially edentulous patients, impairing denture fitting, and have recently been described in the literature as hyperplasias of the sublingual glands. OBJECTIVE: This study aims at describing the microscopic aspects of MFE that contribute to their final diagnosis. METHODS: Twenty-four specimens were surgically removed from the enlarged mouth floor of 19 patients (15 females and 4 males). Patient age ranged from 48 to 74 years, with a mean of 57 years. The main surgical indication was to permit or improve the fitting of dentures. Six patients were completely edentulous and 13 were partially edentulous. The material was processed for microscopic examination and stained with hematoxylin-eosin, Mallory's trichrome and periodic-acid Schiff (PAS). RESULTS AND CONCLUSIONS: The epithelium of the mouth floor was normal in 17 cases, hyperplastic in 4 and atrophic in 3. Six of the 24 sublingual glands removed were microscopically normal, while the other specimens presented acinar atrophy with hyperplasia of duct-like structures. Interstitial fibrosis was observed in 18 cases and was accompanied by adipose tissue infiltration in 15. Decreased lymphoid tissue was observed in 16 samples and oncocytosis was present in 5 cases. We suggest that MFE in edentulous or partially edentulous patients should be considered as an entity for the text books.Tumefações do soalho bucal (TSB) são observadas em pacientes edêntulos ou parcialmente edêntulos, prejudicando a adaptação de próteses, e têm sido descritas recentemente na literatura como hiperplasias das glândulas sublinguais. OBJETIVO: O objetivo desse estudo é descrever os aspectos microscópicos das TSB a fim de contribuir para o seu diagnóstico final. MATERIAL E MÉTODOS: Foram removidos cirurgicamente 24 espécimes de 19 pacientes (15 mulheres e 4 homens) que possuíam TSB. A idade variou de 48 a 74 anos, com média de 57 anos. A principal indicação cirúrgica era permitir ou melhorar a adaptação das próteses. Seis pacientes eram edêntulos e 13, parcialmente edêntulos. O material foi processado para exame microscópico e corado com hematoxilina-eosina, tricrômico de Mallory e ácido periódico de Schiff (PAS). RESULTADOS E CONCLUSÕES: O epitélio do soalho bucal estava normal em 17 casos, hiperplásico em 4 e atrófico em 3. Seis das 24 glândulas sublinguais removidas eram normais microscopicamente, enquanto que as demais apresentaram atrofia acinar com hiperplasia de estruturas ductiformes. Fibrose intersticial foi observada em 18 casos sendo acompanhada por infiltração de tecido adiposo em 15 casos. Uma diminuição no tecido linfóide foi observada em 16 espécimes e oncocitose em 5. Sugerimos que as TSB em pacientes edêntulos e parcialmente edêntulos devem ser classificadas como "entidade" nos livros texto

Avaliação clínica dos efeitos do laser em baixa intensidade (GaAlAs) na cicatrização de gengivoplastia em humanos

Low-intensity laser therapy aims at pain suppression, edema reduction and acceleration of wound healing. The main goal of this study was to clinically evaluate the effects of Aluminum Gallium Arsenate laser - 670nm in wound healing after gingivoplasty in 11 patients. Surgery was performed in anterior superior and/or inferior regions. The right side of the patient (test group) received a laser energy density of 4J/cm², in a 48-hour interval, during one week, totalizing four sessions. The irradiation was punctual in a contact mode in three points. The left side did not receive irradiation (control group). Clinical evaluation was performed by five specialists in periodontology through photography of the treated areas at post-surgical periods of 7, 15, 21,30,60 days. The observers pointed the best healed side. The Sign test was used for statistical analysis with a confidence level of 5% (P;0.05). These results have shown that low-intensity laser therapy did not accelerate oral mucosa healing after gingivoplasty.A terapia com laser em baixa intensidade visa a biomodulação dos tecidos para se obter supressão da dor, redução do edema, e aceleração da cicatrização. O objetivo deste estudo foi avaliar, clinicamente, os efeitos do laser diodo de arseneto de gálio e alumínio (GaAlAs) - 670nm- na cicatrização de gengivoplastias em 11 pacientes. As cirurgias foram realizadas nas regiões anteriores superior e/ou inferior. O lado direito (teste) foi irradiado, na forma pontual, com 4J/cm² por ponto, em três locais diferentes. A aplicação do laser foi feita a cada 48h, durante uma semana, totalizando quatro sessões. O lado esquerdo (controle) não foi irradiado. A avaliação clínica foi feita por cinco periodontistas, através de fotografias dos períodos pós-operatórios de 7,15,21, 30 e 60 dias. Os examinadores apontaram o lado mais bem cicatrizado ou se ambos estavam iguais. Para análise estatística dos dados clínicos, foi utilizado o teste dos sinais com um nível de significância de 5% (

USO DO INTERCÂMBIO POR TROCA DE FIGURA PARA TRATAMENTO ODONTOLÓGICO DO PACIENTE COM SÍNDROME DO X-FRÁGIL: SÉRIE DE CASOS.

A Síndrome do X-Frágil (SXF) é uma alteração genética ligada ao cromossomo X. É uma das causas hereditárias mais comum de déficit cognitivo e um verdadeiro desafio ao cirurgião-dentista. O objetivo dessa série de casos é abordar o manejo comportamental durante o tratamento odontológico em 3 pacientes com síndrome do X-frágil utilizando o sistema de intercâmbio por troca de figuras (PECs). A amostra foi composta por pacientes do gênero masculino com idades de 15 (P1), 19 (P2) e 29 (P3) anos (P1e P2 melanodermas e P3 leucoderma). Todos os pacientes apresentavam alguma necessidade odontológica específica com indicação de tratamento periodontal. Os pacientes apresentavam alto grau de ansiedade e comprometimento severo na comunicação verbal, porém não eram agressivos. Os pacientes P2 e P3 já possuiam histórico de atendimento odontológico anterior somente possível com anestesia geral. Como uma alternativa para verificar a possibilidade de atendimento ambulatorial desses pacientes, foram utilizados os PECs com o objetivo de acolher e facilitar a comunicação. Sua principal importância é antecipar as atividades a serem realizadas, promovendo ambientação, melhorando a comunicação profissional-paciente e diminuindo o estresse do paciente. A partir dessas atividades, foi possível a realização do atendimento ambulatorial sem sedação oral e sem contenção/restrição física em todos os pacientes, sendo superada as dificuldades comunicativas e comportamentais dos mesmos. Portanto, os PECs são importante ferramenta mediadora que pode facilitar a inserção e o manejo do paciente com SXF com alterações neurocognitivas, possibilitando o atendimento odontológico ambulatorial com o objetivo de promover saúde bucal e qualidade de vida a esses pacientes

Newly forming bone graft: a novel surgical approach to the treatment of denuded roots

Many techniques have been proposed for root coverage. However, none of them presents predictable results in deep and wide recessions. OBJECTIVES: The aim of this case series report is to describe an alternative technique for root coverage at sites showing deep recessions and attachment loss >;4 mm at buccal sites. MATERIAL AND METHODS: Four patients presenting deep recession defects at buccal sites (>;4 mm) were treated by the newly forming bone graft technique, which consists in the creation of an alveolar socket at edentulous ridge and transferring of granulation tissue present in this socket to the recession defect after 21 days. Clinical periodontal parameters, including recession depth (RD), probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PI) and keratinized gingiva width (KGW) were evaluated by a single examiner immediately before surgery and at 1, 3, 6 and 9 months postoperatively. RESULTS: All cases showed reduction in RD and PD, along with CAL gain, although no increase in KGW could be observed. These findings suggest that the technique could favor periodontal regeneration along with root coverage, especially in areas showing deep recessions and attachment loss

Vitamina D tem influência nos implantes dentários?

D Vitamin (calciferol) presents an important role in bone metabolism (turnover) and maintenance of calcium and phosphorus levels in blood. The main source of production is sun-stimulated skin. However, characteristics of modern life, such as fear of dermatological damage and use of protective agents, have hindered/reduced sun exposure. In this way, adequate synthesis of this vitamin is impaired, which can affect negatively the clinical success of dental implants. This study aimed to describe the importance of D vitamin and the effect of its deficiency on systemic health and repercussion in dental implants. An electronic search was made in the Scielo, Pubmed and Scopus databases using the descriptors: “deficiency and vitamin D and dental implants”. 13 articles were selected for review and data analysis. Lack or deficiency of D vitamin promoted different alterations such as mild hypocalcaemia, loss of trabecular bone, and severe bone, muscle, immune and metabolic disorders. In case of suspected D vitamin deficiency, patient should be referred to a physician and nutritionist. The existence of possible hypovitaminosis and indication of appropriate therapeutic approach is very important. The studies in vitro and in animals demonstrate the effects of deficiency or effect of vitamin D supplementation on bone metabolism around dental implants. Already the human studies feature great heterogeneity, no link was found between low serum vitamin D levels with an increased risk of early implant loss. Therefore, further research, including longitudinal clinical investigations and systematic reviews, is necessary to better elucidate mechanisms of D vitamin in processes of bone metabolism and osseointegration supporting dentists, physician and nutritionists when in contact with patients who use or will use dental implants

Palatal mucosa derived fibroblasts present an adaptive behavior regarding cytokine secretion when grafted onto the gingival margin

BACKGROUND: Considering that grafted gingival tissue might have to be adapted to the receptor area and that fibroblasts have the ability to respond to bacterial stimuli through the release of various cytokines, this study investigated whether fibroblasts from the palatal mucosa behave differently when grafted onto the gingival margin regarding cytokine secretion. METHODS: Biopsies from the palatal mucosa were collected at the time of free gingival graft surgery, and after four months re-collection was performed upon surgery for root coverage. Fibroblasts were isolated by the explant technique, cultured and stimulated with Porphyromonas gingivalis (Pg) and Escherichia coli (Ec) LPS for 24 or 48 h for comparative evaluation of the secretion of cytokines and chemokines, such as IL-6, IL-8/CXCL8, MIP-1α/CCL3, TGF-β, VEGF and CXCL16. Unstimulated cells were used as the control group. Cells were tested for viability through MTT assay, and secretion of cytokines and chemokines was evaluated in the cell supernatants by Enzyme-Linked Immunosorbent Assay (ELISA). RESULTS: Fibroblasts from the palatal mucosa maintained the same secretion pattern of IL-6 when grafted onto the gingival margin. On the contrary, fibroblasts from the marginal gingival graft showed increased secretion of IL-8/CXCL8 even in the absence of stimulation. Interestingly, MIP-1α/CCL3 secretion by fibroblasts from the marginal gingival graft was significantly increased after 48 hours of stimulation with Pg LPS and after 24 h with Ec LPS. Only fibroblasts from the marginal gingival graft showed secretion of TGF-β. VEGF and CXCL16 secretion were not detected by both subsets of fibroblasts. CONCLUSION: Fibroblasts from the palatal mucosa seem to be adapted to local conditions of the site microenvironment when grafted onto the gingival marginal area. This evidence supports the effective participation of fibroblasts in the homeostasis of the marginal periodontium through secretion modulation of important inflammatory mediators

Newly forming bone graft: a novel surgical approach to the treatment of denuded roots

Many techniques have been proposed for root coverage. However, none of them presents predictable results in deep and wide recessions. Objective: The aim of this case series report is to describe an alternative technique for root coverage at sites showing deep recessions and attachment loss >4 mm at buccal sites. Material and Methods: Four patients presenting deep recession defects at buccal sites (>= 4 mm) were treated by the newly forming bone graft technique, which consists in the creation of an alveolar socket at edentulous ridge and transferring of granulation tissue present in this socket to the recession defect after 21 days. Clinical periodontal parameters, including recession depth (RD), probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PI) and keratinized gingiva width (KGW) were evaluated by a single examiner immediately before surgery and at 1, 3, 6 and 9 months postoperatively. Results: All cases showed reduction in RD and PD, along with CAL gain, although no increase in KGW could be observed. These findings suggest that the technique could favor periodontal regeneration along with root coverage, especially in areas showing deep recessions and attachment loss

Promoção de Saúde Bucal e Síndrome de Down: Inclusão e Qualidade de Vida por meio da Extensão Universitária

A prevenção é essencial para o estabelecimento de saúde bucal dos pacientes, principalmente quando relacionada aos indivíduos com deficiência, como os pacientes com Síndrome de Down (SD). O objetivo deste estudo foi identificar as percepções de pais e/ou responsáveis sobre a saúde bucal e em seguida formular um manual sobre escovação dentária, além de encontrar recursos lúdicos de manejo comportamental para o paciente com SD. Com os participantes com SD foram realizadas oficinas de arte e outras atividades lúdicas com caráter de educação em saúde. Participaram do estudo 15 pacientes com SD com idade entre 3 e 16 anos, com seus respectivos pais/cuidadores da Associação de Pais e Amigos das Pessoas com SD de Lençóis Paulista - SP (Brasil). Observou-se que ainda grande parte dos pais desconhece quais doenças que acometem a cavidade bucal dos pacientes com SD e como isso afeta sua saúde sistêmica. Constatou-se que os participantes com SD aceitaram e adotaram de maneira mais efetiva as instruções de higiene bucal por meio da música fortalecendo o vínculo paciente-profissional. Portanto, atividades de extensão para essa parcela da população são fundamentais para promoção de saúde bucal, inclusão social e qualidade de vida dos mesmos

Evaluation of tissue reaction to Aroeira (Myracrodruon urundeuva) extracts: a histologic and edemogenic study

Objectives: This study evaluated subcutaneous tissue response to Aroeira (Myracrodruon urundeuva) extract employing edemogenic and histological analyses. Material and methods: Test groups consisted of aqueous and ethanolic Aroeira extracts and saline (control). For groups consisted of aqueous and ethanolic Aroeira extracts and saline Blue. After 30 min, the extracts and saline were injected on the dorsum of the rats, which were then sacrificed after 3 and 6 h. Readings were performed in a spectrophotometer. For subcutaneous implantation, 30 rats received a polyethylene tube containing the extracts on their dorsum and then they were killed after 7 and 28 days. The samples were processed for histological analysis and evaluated with a light microscope. The inflammatory infiltrate was quantified. Results: There were no statistically significant differences between aqueous extract and saline groups in relation to edema quantification in the different periods (p > 0.05). Ethanolic solution resulted in more edema independently of the experimental period (p < 0.05). Histological analysis showed similar results on the 7-day period for the 3 groups. There was a notable reduction on inflammatory cell number for saline and aqueous extract groups at 28 days. Conclusion: The aqueous extract showed biocompatible properties similar to those of saline.Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES