CARCINOMA DE CÉLULAS ESCAMOSAS BUCAL: uma revisão de literatura

Squamous cell carcinoma (SCC) is considered a malignant neoplasm, which originates in the lining of the oral cavity and represents approximately 95% of malignant lesions in this area. The mortality rate related to oral OHC varies according to habits, socioeconomic aspects, quality of medical care received, preventive education, ethnicity, environmental factors and life expectancy. However, as the clinical evolution of this process does not always follow the expected clinicopathological criteria, new prognostic elements have been studied. It is usually located on the floor of the mouth and tongue. The objective of this study is to know about the epidemiology, risk factors, diagnosis and treatment, in order to detect and refer them early. The study is characterized as a narrative/conceptual review and a narrative bibliographic review was carried out, using material accessible to the general public, such as books and scientific articles, published in the last ten years through databases available on the internet. The study presents the main risk factors that can trigger HCC, including: smoking, alcoholism, diet, immunosuppression; hereditary factors and HPV infections. The study allowed us to verify the importance of an early diagnosis by the dentist to ensure adequate treatment, favorable prognosis and better quality of life for patients. It is concluded that accurate oral clinical examination is very important in all oral lesions, even if the main symptom is not focused on this point. For individuals who are at higher risk, a thorough examination should be performed and those who present suspicious lesions, referred for a specialized consultation.El carcinoma de células escamosas (CCE) se considera una neoplasia maligna, que se origina en el revestimiento de la cavidad oral y representa aproximadamente el 95% de las lesiones malignas en esta zona. La tasa de mortalidad relacionada con la OHC oral varía según los hábitos, los aspectos socioeconómicos, la calidad de la atención médica recibida, la educación preventiva, la etnia, los factores ambientales y la esperanza de vida. Sin embargo, como la evolución clínica de este proceso no siempre sigue los criterios clínico-patológicos esperados, se han estudiado nuevos elementos pronósticos. Por lo general, se ubica en el piso de la boca y la lengua. El objetivo de este estudio es conocer la epidemiología, los factores de riesgo, el diagnóstico y el tratamiento, con el fin de detectarlos y derivarlos de forma precoz. El estudio se caracteriza por ser una revisión narrativa / conceptual y se realizó una revisión bibliográfica narrativa, utilizando material accesible al público en general, como libros y artículos científicos, publicados en los últimos diez años a través de bases de datos disponibles en Internet. El estudio presenta los principales factores de riesgo que pueden desencadenar el CHC, entre ellos: tabaquismo, alcoholismo, dieta, inmunosupresión; factores hereditarios e infecciones por VPH. El estudio permitió comprobar la importancia de un diagnóstico precoz por parte del odontólogo para asegurar un tratamiento adecuado, pronóstico favorable y mejor calidad de vida de los pacientes. Se concluye que la exploración clínica oral precisa es muy importante en todas las lesiones bucales, incluso si el síntoma principal no se centra en este punto. En el caso de las personas de mayor riesgo se debe realizar una exploración exhaustiva y las que presenten lesiones sospechosas, derivar a una consulta especializada.O carcinoma de células escamosas (CCE) é considerado uma neoplasia maligna, que se origina no revestimento da cavidade oral e representa aproximadamente 95% das lesões malignas nessa área. O índice de mortalidade referente ao CCE bucal é variável de acordo com os hábitos, aspectos socioeconômicos, qualidade da assistência médica recebida, educação preventiva, etnia, fatores ambientais e expectativa de vida. Porém, como a evolução clínica desse processo nem sempre segue os critérios clínico-patológicos previstos, novos elementos prognósticos têm sido estudados. Geralmente está localizado na parte do assoalho da boca e da língua. O objetivo deste estudo é conhecer sobre a epidemiologia, os fatores de risco, o diagnóstico e o tratamento, a fim da sua detecção e encaminhamento precoce. O estudo é caracterizado como uma revisão narrativa/conceitual e foi realizado uma revisão bibliográfica narrativa, feita através de material acessível ao público em geral, tais como livros, e artigos científicos, publicados nos últimos dez anos através de bases de dados disponíveis na internet. O estudo apresenta os principais fatores de risco que podem desencadear o CCE, entre eles: tabagismo, alcoolismo, dieta, imunossupressão; fatores hereditários e infecções pelo HPV. O estudo permitiu verificar a importância de um diagnóstico precoce pelo dentista para garantir o tratamento adequado, prognóstico favorável e melhor qualidade de vida para os pacientes. Conclui-se que o exame clínico oral preciso é muito importante em todas as lesões orais, mesmo que o sintoma principal não seja focado neste ponto. Para indivíduos que possuem um risco maior, deve-se realizar um exame minucioso e aqueles que apresentarem lesões suspeitas, encaminhados para uma consulta especializada

A parallel 3‐group randomised clinical trial comparing different implant treatment options for the edentulous mandible: 1‐year effects on dental patient‐reported outcomes and chewing function

OBJECTIVE This parallel three-group randomised clinical trial compared the 1-year changes in dental patient-reported outcomes and chewing function associated with three treatment strategies for the edentulous mandible: single-implant (G-I; n = 11) or two-implant overdentures (G-II; n = 13), and fixed 4-implant complete denture (G-III; n = 13). METHODS Complete denture (CD) treatment was provided to all participants and after an adaptation period, they were randomly assigned to one of the three study groups. Implants (Neodent TI Cortical, Brazil) were inserted using single-stage surgery and conventional loading. The mandibular dentures were incorporated into implants using specific retention systems and procedures according to the treatment group: O'ring/ball attachments for G-I and GII, and mini-conical abutments for G-III. Patients were assessed at baseline (CD stage) and up to 1-year after implant-retained prosthodontic treatment. Treatment outcomes included oral health-related quality of life (OHIP-Edent), satisfaction with the dentures and chewing function using a mixing ability test. Data analyses included pairwise comparison tests, estimates of effect sizes and regression analysis using Generalized Estimating Equations. RESULTS Results showed improvement in patient-reported outcomes (lower OHIP-Edent scores and higher satisfaction) and chewing function, compared to baseline. No significant between-group differences were found, although effect sizes were lower for G-III. CONCLUSIONS All treatments improved the assessed outcomes after transition from the baseline condition. Findings suggest that simplified implant treatments for edentulous patients result in favourable outcomes and may be considered as suitable alternatives to more complex interventions

A parallel 3-group randomised clinical trial comparing different implant treatment options for the edentulous mandible: 1-year effects on dental patient-reported outcomes and chewing function.

OBJECTIVE This parallel three-group randomised clinical trial compared the 1-year changes in dental patient-reported outcomes and chewing function associated with three treatment strategies for the edentulous mandible: single-implant (G-I; n = 11) or two-implant overdentures (G-II; n = 13), and fixed 4-implant complete denture (G-III; n = 13). METHODS Complete denture (CD) treatment was provided to all participants and after an adaptation period, they were randomly assigned to one of the three study groups. Implants (Neodent TI Cortical, Brazil) were inserted using single-stage surgery and conventional loading. The mandibular dentures were incorporated into implants using specific retention systems and procedures according to the treatment group: O'ring/ball attachments for G-I and GII, and mini-conical abutments for G-III. Patients were assessed at baseline (CD stage) and up to 1-year after implant-retained prosthodontic treatment. Treatment outcomes included oral health-related quality of life (OHIP-Edent), satisfaction with the dentures and chewing function using a mixing ability test. Data analyses included pairwise comparison tests, estimates of effect sizes and regression analysis using Generalized Estimating Equations. RESULTS Results showed improvement in patient-reported outcomes (lower OHIP-Edent scores and higher satisfaction) and chewing function, compared to baseline. No significant between-group differences were found, although effect sizes were lower for G-III. CONCLUSIONS All treatments improved the assessed outcomes after transition from the baseline condition. Findings suggest that simplified implant treatments for edentulous patients result in favourable outcomes and may be considered as suitable alternatives to more complex interventions

Cost-effectiveness of three different concepts for the rehabilitation of edentulous mandibles: overdentures with 1 or 2 implant attachments and hybrid prosthesis on four implants

Background There is scarce data regarding the combined assessment of the costs and effects of implant treatments for edentulous patients when multiple options are available. Aim This randomized clinical trial aimed to assess the cost‐effectiveness of three different concepts for treatment: mandibular overdenture retained by a single (Group I; n=11) or two implants (Group II; n=13), and fixed hybrid prosthesis on four implants (Group III; n=13). Methods Treatment effectiveness was measured as the 1‐year before‐after changes in patient satisfaction with the mandibular prosthesis. Costs were prospectively quantified from the perspective of the health provider, including all direct cost items attributed to the delivery of treatments and up to the 1‐year follow‐up, using a “bottom‐up” costing estimation method. Results Patient satisfaction after treatment improved significantly for the three groups. The overall costs were R$2,370.66, R$ 3,185.21, and R$ 5,739.52 for Groups I, II and III, respectively (p<0.001). Analysis of incremental cost‐effectiveness ratios suggested that the overdentures retained by one or two implants, were more cost‐effective than the fixed implant treatment, considering the mean cost and effectiveness values and the ±20% one‐way sensitivity analysis. Conclusion This study suggests that the incremental costs for the fixed hybrid prosthesis, compared to the overdenture treatments, is not proportional to the respective gain in effectiveness. Therefore, although all treatment options had satisfactory outcomes, the use of implants to retain a mandibular overdenture, irrespective of the use of one or two implants, is more cost‐effective than the fixed implant treatment for the edentulous mandible