Avaliação histometrica da utilização de regeneração ossea guiada (PTFE) e enxerto osseo (Bio-Oss), isolados ou em combinação, no tratamento de defeitos osseos resultantes da peri-implantite induzida em cães

Orientador: Francisco Humberto Nociti JuniorTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ondotologia de PiracicabaResumo: o objetivo deste estudo foi avaliar histometricamente em cães, a utilização de regeneração óssea guiada e enxerto ósseo heterógeno mineralizado, isolados ou em combinação, no tratamento de defeitos ósseos resultantes da peri-implantite induzida. Cinco cães foram utilizados e seus pré molares mandibulares (P2, P3, P 4) foram extraídos.. Após 3 meses, 2 implantes de titânio (Sistema Napio de Implantes@, Bauru - SP, Brasil) foram colocados de cada lado da mandíbula. Decorridos 3 meses os intermediários foram conectados, e após 15 dias a peri-implantite foi induzida através da colocação de ligadura de algodão ao redor e em posição submarginal ao intermediário. Trinta dias mais tarde, as ligaduras foram removidas e um regime de higiene oral foi iniciado. Após 2 semanas, os defeitos ósseos foram tratados, utilizando-se quatro diferentes modalidades de tratamentos, aleatoriamente propostas: (I) descontaminação - DE, (2) descontaminação associada à regeneração óssea guiada (pTFE) e enxerto ósseo (Bio-Oss@) - ROGIEO + DE, (3) descotitaminação associada à regeneração óssea guiada - ROG + DE e (4) descontaminação associada ao enxerto ósseo - EO + DE. Os -animais foram sacrificados 5 meses após o início do tratamento e os implantes e tecidos duros circundantes foram processados para avaliação histológica. Os parâmetros histométricos avaliados foram a área de tecido ósseo neoformado e a extensão de tecido ósseo em contato direto com a superficie do implante. Os resultados obtidos não demonstraram diferença estatisticamente significante entre as modalidades de tratamento propostas ANOV A, (P>O,05). Dentro dos limites do presente estudo, a neoformação óssea e a reosseointegração ao redor da superficie do implante previamente exposta à contaminantes ocorreram em grau varíavel para todas as modalidades de tratamentoAbstract: The purpose of the present study was to evaluate, histometrically, the treatment of ligature-induced peri-implantitis using guided bone regeneration and/or bone graft. Five dogs were used and their mandibular premolars (P2, P3 and P 4) were removed. After 3 months ofhealing, two titanium implants (Napio Systern~, Bauru - SP, Brasil) were placed on each side ofthe mandible. Afier 3 months, the abutment connection was perfonned and an experimental peri-implantitis was induced by the placement of cotton ligatures around and submarginal position alI abutrnents. Ligatures and abutments were rernoved third days later, and an plaque control regime was iniciated. Afier fifteen days the peri-implant bone defects were randorn1y assigned to qne of the treatrnents: (1) debridement, - DE, (2) debridement plus guided bone regeneration (PTFE) associated with mineralized bone graft (Bio-Oss@) - ROG/EO + DE, (3) debridement plus guided bone regeneration - ROG + DE and (4).debridement plus mineralized bone graft - EO + DE. Five months later, the animaIs were sacrificed, and the implants with their supporting peri-implant tissues were processed for histologic evaluation. The degree ofbone contact with the implant surface and the area of bone tissue neoformed was evaluated histometrically. The analysis of variance (ANOV A) was used for statistical ana1ysis and did not reveal statistical significant differences between the treatment modalities (P>O,05). Within the limits of the present study, there were some new bone formation around the exposed implant surface, although true reosseointegration appears in variable degrees for alI treatrnents modalitiesDoutoradoPeriodontiaDoutor em Clínica Odontológic

Complications in third molar removal : a retrospective study of 588 patients

Objectives: Surgical removal of third molars is a regular surgical procedure, which like all operations, may have complications. The purpose of the study was to analyze the incidence of complications and their relationship with the surgical difficulty in a group of 588 patients treated by the same oral and maxillofacial surgeon. Study design: This retrospective cohort study consisted of 1699 third molars (M3) removed between 2005 and 2008. The teeth were grouped into a 6-class scale of surgical difficulty rated according to the surgical procedure description in the patient?s file: I: upper M3 requiring forceps only; II: upper M3 requiring osteotomy; III: upper M3 requiring osteotomy and tooth section; IV: lower M3 requiring forceps only; V: lower M3 requiring osteotomy; VI: lower M3 requiring osteotomy and tooth section. The complications were grouped into each surgical difficulty class and their incidence and management were also described. Results: 59 complications (3.47%), including pain, root tip fracture, paresthesia, alveolar osteitis, temporomandibular joint discomfort, and oroantral fistula were reported. Surgical difficulty class VI presented the higher incidence of complications (n=38). Conclusions: The risk of complications in third molar surgery will always exist and increases in proportion to the surgical difficulty. Mandibular M3 requiring osteotomy and tooth section have the highest risk of complications

Oral manifestations of celiac disease : a case report and review of the literature

Celiac disease is a chronic intestinal disease caused by intolerance to gluten associated with poor digestion and absorption of the majority of nutrients and vitamins, which may affect both developing dentition and oral mucosa. The aim of this study is to make a brief review of the literature about celiac disease and to report on a clinical case, showing the impact it may have on the general and oral health. A 39-year-old woman reported the presence of diarrhea, nauseas, flatulence, colic, difficulty with falling asleep, lack of appetite and loose of 18 Kg in the last two years. She also noted the appearance of symptomatic lesions in the mouth. These lesions had a mean duration of a month and occurred in any region of the oral mucosa, particularly on the tongue. Multiples ulcerations were found in the sublingual caruncula region, at the vestibular fornix and at the lingual apex. Topical treatment was instituted for the oral lesions with immediately relief of the symptoms. The diagnosis of celiac disease was established by means of medical clinical exam, biopsy of the small intestine, and by the presence of specific antibodies in the blood. The patient has been instructed to follow a gluten-free diet. Multiprofessional action with the involvement of a gastroenterologist and other health professionals, such as dentists, is important for diagnosing the disease and guiding the patient with celiac disease to achieve a good quality of life

Keratocystic odontogenic tumor: case report

Introdução: o tumor odontogênico ceratocístico (TOC) é uma lesão oral e maxilofacial relativamente comum que surge de restos da lâmina dental. Ele tem um comportamento agressivo, incluindo altas taxas de recorrência, crescimento rápido e extensão para os tecidos adjacentes. Várias modalidades de tratamento e, assim, diferentes taxas de recorrência após o tratamento, foram relatadas. Devido ao revestimento muito fino e friável, característica do tumor, a enucleação pode ser difícil e, por esta razão ele é associado com as maiores taxas de recorrência. Objetivo: o presente trabalho descreve um caso de um grande TOC no corpo mandibular, onde, devido à presença de um revestimento de espessura incomum, a remoção do tumor como uma peça única foi bem sucedida. Conclusão: o presente caso demonstra que TOC de grandes proporções podem ser tratados de maneira conservadora. Devido à possibilidade de recidiva em muitos anos após o tratamento inicial, acompanhamento a longo prazo é obrigatório. Palavras-chave: Tumor Odontogênico Queratocístico; Revestimento; Cirurgia Oral

Analise dos heredogramas e das correlações clinicas da fibromatose gengival hereditaria, numa familia de 219 pessoas

Orientador: Lourenço BozzoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A F.G.H. como entidade isolada e não associada a síndromes, foi diagnosticada em um grupo familial há aproximadamente 15 anos. Atualmente este grupo se apresenta constituído no total de 219 indivíduos, dos quais 159 descendentes diretos apresentam risco de herdar a alteração. A análise de cinco gerações em dez heredogramas neste grupo familial mostrou que 64 indivíduos foram afetados e que a transmissão da fibromatose gengival ocorreu através de um gene autossômico dominante, a partir de um único indivíduo afetado. Diferentes formas de expressão clínica da F.G.H. foram observadas em indivíduos com idades similares em um mesmo heredograma deste grupo familial, confirmando a hipótese de expressividade variável deste gen. Os achados clínicos se mostraram dependentes do grau de expressão da F.G.H., revelando que quanto maior a expressão fenotípica, maior o aumento gengival e maior a chance de encontrar maloclusão. Os achados clínicos secundários a fibromatose gengival, mais freqüentes no grupo familial estudado, foram, o mal posicionamento dentário, falta de vedamento labial, ,respiração bucal e diastemas generalizados no arco superior e inferior, em conseqüência do spessamento gengiva!. A F.G.H. não foi detectada em .alguns heredogramas nas cinco gerações e estes indivíduos não portadores, não transmitiram para seus descendentes a F.G., sugerindo que a penetrância deste gene autossômico" dominante é completa. Estas conclusões estão em consonância com observações de outros autores, já descritas na literaturaAbstract: The hereditary gingival fibromatosis, as an isolated entity, has been diagnosed in a family group for approximately fifteen years. Nowadays this is a 219 persons group, of whom 159 have a chance to inherit the disorder. The evaluation, in ten genetic pedigree, of five generations in this family group, showed 64 atfected persons and that the transmission of the gingival fibromatosis was due to an autosomal dominant gen, proceeding from a single atfected person. A wide variability in expression of the hereditary gingival fibromatosis has been reported in persons of similar ages in a common pedigree of this family group, attesting the hypothesis of variable expressivity of this gene. Clínical findings showed to be dependent of the expression leveI of the her~ditary gingival fibromatosis, showing that the larger is the fenotipic expression, the larger is the gingival enlargement, and the larger is the chances of maloclusion. The secundary clinicals findings to the hereditary gingival fibromatosis most common shówed in this family group were, crowding, lack of labial closure, bucal breathing and generalized spacing on upper and lower archs, due to the excessive gengival bulk. The hereditary gingival fibromatosis was not found in some pedigrees of the five generations and those non afIected persons did not transmit the hereditary gingival fibromatosis to their descendents, suggesting that penetrance of this autosomal dominant gene is complete. Those conclusions were in conformity whith others author' s observations, reported in the literature. In this family group, the hereditary gingival fibromatosis was the only disorder found, not being associated with any other genetic syndromesMestradoMestre em Ciência

Treatment of symptomatic oral lichen planus: a literature review

Lichen planus (LP) is a relatively common chronic inflammatory mucocutaneous disease. The aetiology is un-known, but appears to be mediated by the immune system. Emotional factors such as stress and anxiety are as-sociated with oral lichen planus (OLP). It affects a higher percentage of middle-aged females. Erosive/ulcerative lesions are accompanied by symptoms such as severe pain and burning sensation, which vary according to the de-gree of inflammation. The main treatment of symptomatic OLP includes the use of topical corticosteroid drugs. Al-ternative treatments include immunosuppressants, retinoids, laser therapy, photodynamic therapy, aloe vera and green tea. The objective of this literature review was to describe the effective treatments for symptomatic OLP le-sions. It was concluded that topical therapy is the most widely used treatment for symptomatic lesions of OLP. Clo-betasol propionate mouthwash was the most used anti-inflammatory drug even though it has the same efficacy as other treatments. There is no stipulated duration of topical treatment for clobetasol propionate and should be used until the complete remission of the symptoms

Leczenie objawowego liszaja płaskiego jamy ustnej: przegląd literatury

Liszaj płaski (ang. lichen planus, LP) jest stosunkowo częstą, przewlekłą chorobą zapalną skóry i błon śluzowych. Jego etiologia pozostaje nieznana, ale może mieć związek z funkcjonowaniem układu immunologicznego. Czynniki emocjonalne, takie jak stres i niepokój, odgrywają rolę w liszaju płaskim jamy ustnej (ang. oral lichen planus, OLP) i wpływają na większy odsetek występowania tej choroby wśród kobiet w wieku średnim. Zmianom erozyjnym/wrzodziejącym towarzyszą objawy silnego bólu i pieczenia, które różnią się w zależności od stopnia nasilenia stanu zapalnego. Stosowanie kortykosteroidów miejscowych jest podstawowym leczeniem objawowego OLP. Alternatywne metody stanowią leki immunosupresyjne, retinoidy, laseroterapia, terapia fotodynamiczna, preparaty aloesu i zielona herbata. Celem niniejszego przeglądu literatury było określenie skutecznych metod leczenia objawowego OLP. Stwierdzono, że najpowszechniejszym sposobem postępowania w objawowym OLP jest leczenie miejscowe. Najczęściej stosowanym leczeniem przeciwzapalnym jest płukanie jamy ustnej propionianem klobetazolu, mimo takiej samej skuteczności innych leków. Czas leczenia miejscowego propionianem klobetazolu nie jest określony i powinien trwać aż do całkowitego ustąpienia objawów

Exfoliative Cytology in the Oral Mucosa of Patients with Fanconi Anaemia: A Morphometric Approach

Patients with Fanconi anaemia (FA) are prone to develop squamous cell carcinomas at an early age. Exfoliative cytology can be used to detect changes to the health of the oral mucosa. Objective: The aim of this study was to evaluate morphometrical and morphological changes using exfoliative cytology and to analyse and quantify the proliferative activity using silver nucleolar organiser regions (AgNOR) in epithelial cells of the tongue in FA patients,after haematopoietic stem cell transplantation (HSCT). Methods: Oral smears were collected from the tongues of 20 FA children and adolescents after haematopoietic stem cell transplantation (FA) and 20 healthy children (C) using exfoliative cytology. The smears were stained using the Papanicolaou technique and silver impregnation. The cells were morphologically analysed and the nuclear area (NA), the cytoplasmic area (CA), and the nucleusto-cytoplasm area ratio (NA/CA) were calculated. Results: Mean values for the FA and C groups were: NA (71.85 and 55.21μm.; p< 0.01); CA (2127.48 and 1441.61μm.; p< 0.01); NA/CA (0.03 and 0.04; p< 0.01), respectively. A significant increase in the NA and CA for the FA group (p< 0.01) was seen, and an alteration in the NA/CA ratio. No morphological differences were found between the groups. Class I smears were predominant in both groups. No differences were found between the groups for the mean values of AgNORs per nucleus. Conclusion: This study suggests that morphological changes occurred in the oral epithelium cells of children and adolescents with Fanconi anaemia when subjected to HSCT

Low virulent oral Candida albicans strains isolated from smokers

It is widely accepted that tabagism is a predisposing factor to oral candidosis and cumulate data suggest that cigarette compounds may increase candidal virulence. To verify if enhanced virulence occurs in Candida albicans from chronic smokers, a cohort of 42 non-smokers and other of 58 smokers (all with excellent oral conditions and without signs of candidosis) were swabbed on tong dorsum and jugal mucosa. Results showed that oral candidal loads do not differ between smoker and non-smokers. Activities of secreted aspartyl-protease (Sap), phospholipase, chondroitinase, esterase-lipase, and haemolysin secretions were screened for thirty-two C. albicans isolates. There were detected significant increments in phospholipasic and chondroitinasic activities in isolates from non-smokers. For other virulence factors, no differences between both cohorts were achieved