New methodology for evaluating osteoclastic activity induced by orthodontic load

Orthodontic tooth movement (OTM) is a dynamic process of bone modeling involving osteoclast-driven resorption on the compression side. Consequently, to estimate the influence of various situations on tooth movement, experimental studies need to analyze this cell. Objectives The aim of this study was to test and validate a new method for evaluating osteoclastic activity stimulated by mechanical loading based on the fractal analysis of the periodontal ligament (PDL)-bone interface. Material and Methods The mandibular right first molars of 14 rabbits were tipped mesially by a coil spring exerting a constant force of 85 cN. To evaluate the actual influence of osteoclasts on fractal dimension of bone surface, alendronate (3 mg/Kg) was injected weekly in seven of those rabbits. After 21 days, the animals were killed and their jaws were processed for histological evaluation. Osteoclast counts and fractal analysis (by the box counting method) of the PDL-bone interface were performed in histological sections of the right and left sides of the mandible. Results An increase in the number of osteoclasts and in fractal dimension after OTM only happened when alendronate was not administered. Strong correlation was found between the number of osteoclasts and fractal dimension. Conclusions Our results suggest that osteoclastic activity leads to an increase in bone surface irregularity, which can be quantified by its fractal dimension. This makes fractal analysis by the box counting method a potential tool for the assessment of osteoclastic activity on bone surfaces in microscopic examination

Ameloblastomas mimicking apical periodontitis:a case series

Ameloblastomas are benign odontogenic tumors that can eventually mimic the clinical and radiological features of apical periodontitis. The aim of the present study was to evaluate the clinical, radiological and histological characteristics from a series of ameloblastomas mimicking apical periodontitis diagnosed in a 14-year period. all cases histologically diagnosed as ameloblastomas from 2005 to 2018 presenting a clinical diagnosis of periapical lesion of endodontic origin were selected for the study. Clinical, radiological and histological characteristics from all cases were tabulated and descriptively and comparatively analyzed. Twenty cases composed the final sample, including 18 solid and 2 unicystic ameloblastomas. Mean age of the affected patients was in the fifth decade with predilection for males (72%). The most common anatomical location was the posterior mandible (55%) and most cases presented a radiolucent unilocular (80%) well-defined (95%) image. Most cases were asymptomatic, but the presence of local swelling and bone cortical rupture were common. Ameloblastomas mimicking periapical lesions of endodontic origin are mostly diagnosed in adult males as well-defined radiolucent unilocular lesions producing local swelling and bone cortical rupture

Geographic stomatitis : an enigmatic condition with multiple clinical presentations

Geographic stomatitis is an uncommon inflammatory condition of unknown etiology. It is characterized by reddish areas surrounded by white borders affecting any location in the oral cavity and presenting a migratory and cyclic pattern. The most common affected sites include buccal mucosa, labial mucosa and mucobuccal fold. Some patients can complain of pain or burning sensation. There are few reports in the literature about this entity and its relationship with other oral and cutaneous conditions such as fissured tongue, Reiter?s syndrome, atopy and psoriasis has been suggested but it is still controversial. In the present study we describe three cases of geographic stomatitis associated with fissured tongue. Lesions involved the buccal mucosa, labial mucosa, soft palate and mucobuccal fold and all cases were diagnosed based on their clinical features. All patients were oriented about the innocuous behavior of the condition and were advised to avoid exposure of the lesions to irritation factors. The three presented cases highlighted the importance of a detailed oral mucosal examination by clinicians and provided further information about the natural history and clinical presentation of geographic stomatitis

Nonendodontic periapical lesions:a retrospective descriptive study in a Brazilian population

Several nonendodontic diseases can occur in the periapical region, resembling endodontic inflammatory conditions. Therefore, the aim of the present study was to determine the frequency of nonendodontic periapical lesions diagnosed in a Brazilian population. The files of two Oral Pathology laboratories were reviewed and all cases including at least one clinical diagnosis of endodontic periapical lesions were selected for the study. After initial selection, demographic and clinical data, clinical diagnosis and final diagnosis were reviewed and tabulated. Final diagnosis included endodontic periapical lesions, and benign and malignant nonendodontic periapical lesions. Data were descriptively and comparatively analyzed among the three groups, with a significance level of 5% (p0.05). The frequency of nonendodontic periapical lesions was high and, although the general distribution was similar to the results from other populations, some features were probably associated with the profile of the studied populations and to the methods applied in the present study. Knowledge on differential diagnosis of endodontic and nonendodontic periapical lesions is essential to avoid unnecessary treatments and diagnostic delay in routine dental practice

Avaliação de mastócitos em cistos periapicais, cistos dentígeros e tumores odontogênicos ceratocísticos

Mast cells are found in the connective tissue and can participate in acute and chronic inflammatory responses and induce early and also late-phase reactions. Mast cells are distributed in odontogenic cysts and tumors and it has been suggested that mast cell degranulation products can be related to matrix degradation in the cystic or tumor and to the production of cytokines, which appear to have important functions in bone resorption and cystic growth. The aim of this study was to evaluate the frequency and distribution of mast cells in periapical and dentigerous cysts, and keratocystic odontogenic tumors. Paraffin embedded specimens from 20 periapical cysts, 20 dentigerous cysts (14 with and six without inflammation) and 20 keratocystic odontogenic tumors (16 with and four without inflammation) were selected from the files of the Department of Pathology of the Antonio Pedro Universitary Hospital/Fluminense Federal University. Hematoxylin and eosin stained slides were reviewed through optical microscopy in all cases for diagnosis confirmation by light microscopy. Demographic, clinical and radiographic data from all cases were retrieved from the laboratory records. For observation of mast cells, all 60 cases were evaluated through toluidine blue staining and immunohistochemical reaction with antibody directed against mast cell tryptase. Mast cells were quantified using the Image Pro-Plus 4.5 program (Media Cybernetics, USA) by two techniques in 10 high power fields (40x) and was obtained the mean number of mast cells in three locations: epithelial, superficial fibrous wall and deep fibrous wall. The mean number of mast cells in each region was compared in the three groups of lesions and also was compared the mean number between the different locations to each one of the lesions studied, giving their quantification and distribution profile and descriptive comparison. The distribution of mast cells evaluated through immunohistochemistry was higher in the group of inflamed dentigerous cysts (2,9 cells/high power field), followed by periapical cysts (1,5 cells/high power field), inflamed keratocystic odontogenic tumor (1,3 cells/high power field) and non inflamed dentigerous cysts (0) and non inflammed keratocystic odontogenic tumor (0). In contrast, the distribution of mast cells observed through immunohistochemistry revealed that periapical cysts showed the higher mean (5,3 cells/high power field), followed by inflamed dentigerous cysts (4,7 cells/high power field), inflamed keratocystic odontogenic tumor (3,7 cells/high power field), non inflamed keratocystic odontogenic tumor (2 cells/high power field) and non inflamed dentigerous cyst (0,9 cells/high power field). The deep portion of the fibrous wall presented the higher mean of the mast cells in the three groups of lesions studied, through both techniques, in comparison to the epithelial and superficial regions, except for the non inflamed keratocystic odontogenic tumor analyzed through immunohistochemistry, which showed a higher number of mast cells in the superficial region of the fibrous wall. The increased number of mast cells in lesions with inflammation and at sities of inflammation indicates the participation of these cells in the inflammatory response. The predominance of mast cells, a lot of them degranulated, in the deep region of the fibrous cystic wall may suggest a higher cellular activity possibly related to bone resorption and growth of these lesions. More studies investigating the mediators of inflammation and bone resorption are needed to confirm the role of mast cells in the pathogenesis and behavior of the cystic lesionsMastócitos são células localizadas no tecido conjuntivo que participam de diversas respostas inflamatórias agudas e crônicas, induzindo respostas de reação imediata e tardia. Têm sido encontrados em diversos cistos e tumores odontogênicos e sugere-se que seus produtos de desgranulação, incluindo enzimas e citocinas, possam estar relacionados à degradação da matriz conjuntiva na parede cística ou tumoral e ser importantes no processo de reabsorção óssea, facilitando o crescimento destas lesões. Este estudo teve por objetivo avaliar a frequência e a distribuição dos mastócitos em lesões odontogênicas de morfologia cística e, para isso, foram utilizados espécimes incluídos em parafina de 20 cistos periapicais, 20 cistos dentígeros (seis sem inflamação e 14 com inflamação) e 20 tumores odontogênicos ceratocísticos (quatro sem inflamação e 16 com inflamação) oriundos do arquivo do Serviço de Anatomia Patológica do Hospital Universitário Antonio Pedro/Universidade Federal Fluminense. Todos os casos foram revisados microscopicamente na coloração de hematoxilina e eosina para confirmação do diagnóstico através de microscopia óptica. Os dados demográficos e clínico-radiográficos de todos os casos foram obtidos através de consulta às requisições laboratoriais. Para a avaliação dos mastócitos os 60 casos foram avaliados pela coloração de azul de toluidina e pela reação de imuno-histoquímica da expressão do anticorpo anti-triptase para mastócitos. Os mastócitos foram quantificados com auxílio do programa Image Pro-Plus 4.5 (Media Cybernetics, EUA) pelas duas técnicas em 10 campos de grande aumento (40x) e foi obtido o índice médio do número de mastócitos em três localizações: epitelial, parede fibrosa superficial e parede fibrosa profunda. A média do número de mastócitos de cada região foi comparada entre os grupos de lesões estudadas, assim como foram comparadas as médias entre as diferentes localizações para cada uma das lesões, permitindo obter sua quantificação e o perfil de distribuição e comparação descritiva. A média de distribuição de mastócitos por campo por meio da técnica histoquímica foi superior no grupo dos cistos dentígeros inflamados (2,9 células) do que no cisto periapical (1,5 células), tumor odontogênico ceratocístico inflamado (1,3 células) e cistos dentígeros e tumores odontogênicos ceratocisticos não inflamados (0). Entretanto, pela técnica imuno-histoquímica, o grupo de lesões que apresentou a maior média do número de células foi o do cisto periapical (5,3 células) seguido do cisto dentígero inflamado (4,7 células), tumor odontogênico ceratocístico inflamado (3,7 células) e não inflamado (2 células) e cisto dentígero não inflamado (0,9 células). A região profunda das lesões em ambas as técnicas, apresentou a maior média de mastócitos, à exceção do tumor odontogênico ceratocístico não inflamado, que na técnica imuno-histoquímica apresentou maior número de mastócitos na região superficial. A maior quantidade de mastócitos nas lesões com inflamação indica a participação dessas células na resposta inflamatória nestas entidades. O predomínio de mastócitos, muito deles desgranulados, na parede cística profunda das lesões, sugere maior atividade celular possivelmente relacionada à reabsorção óssea e crescimento das lesões. Mais estudos investigando os mediadores da inflamação e da reabsorção óssea são necessários para confirmar o papel dos mastócitos na patogênese e no comportamento das lesões císticas odontogênica

Estomatite de contato a creme dental: importância do diagnóstico diferencial

Objective: the aim of the present study is to report four cases of toothpaste-related contact stomatitis focusing on their clinical presentation and the importance of differential diagnosis with other reactive, inflammatory and potentially malignant disorders of the oral cavity. Case report: the four cases affected adult females and presented as multifocal whitish and/or erythematous patches and plaques affecting the tongue, floor of mouth, and labial mucosa, showing mild burning sensation, and lasting 7 to 15 days. All patients reported starting the use of new toothpastes few days before the onset of the symptoms and all lesions disappeared in 5 to 7 days after suspension of its use. Conclusion: contact stomatitis to toothpastes should be considered in the differential diagnosis of oral white and red patches and plaques, and detailed clinical history is essential for prompt and correct final diagnosis. As the use of new oral rinses, toothpastes and other oral hygiene products is increasing, clinicians should be aware of the possibility of oral local reactions associated with their use.Objetivo: o objetivo do presente trabalho é relatar 4 casos de estomatite de contato relacionada a cremes dentais com foco em sua apresentação clínica e a importância do diagnóstico diferencial com outras condições reativas, inflamatórias e potencialmente malignas da cavidade oral. Relato de caso: os 4 casos envolveram mulheres adultas e apresentaram-se clinicamente como manchas e placas brancas e vermelhas multifocais acometendo a língua, o assoalho de boca e a mucosa labial, associadas a discreta sensação de queimação e com evolução de 7 a 15 dias. Todas as pacientes relataram terem iniciado o uso de um novo creme dental poucos dias antes do surgimento dos sintomas e todas as lesões desapareceram em um intervalo de 5 a 7 dias após a suspensão do seu uso. Conclusão: estomatite de contato relacionada a cremes dentais deve ser considerada no diagnóstico diferencial das manchas e placas brancas e vermelhas da cavidade oral, e a história clínica detalhada é essencial para o diagnóstico final correto e precoce. Como o uso de novos enxaguatórios e cremes dentais, assim como de outros produtos de higiene oral, vem aumentando, dentistas clínicos devem estar atentos a possibilidade de reações locais orais associadas ao seu uso

New methodology for evaluating osteoclastic activity induced by orthodontic load

Orthodontic tooth movement (OTM) is a dynamic process of bone modeling involving osteoclast-driven resorption on the compression side. Consequently, to estimate the influence of various situations on tooth movement, experimental studies need to analyze this cell. Objectives The aim of this study was to test and validate a new method for evaluating osteoclastic activity stimulated by mechanical loading based on the fractal analysis of the periodontal ligament (PDL)-bone interface. Material and Methods The mandibular right first molars of 14 rabbits were tipped mesially by a coil spring exerting a constant force of 85 cN. To evaluate the actual influence of osteoclasts on fractal dimension of bone surface, alendronate (3 mg/Kg) was injected weekly in seven of those rabbits. After 21 days, the animals were killed and their jaws were processed for histological evaluation. Osteoclast counts and fractal analysis (by the box counting method) of the PDL-bone interface were performed in histological sections of the right and left sides of the mandible. Results An increase in the number of osteoclasts and in fractal dimension after OTM only happened when alendronate was not administered. Strong correlation was found between the number of osteoclasts and fractal dimension. Conclusions Our results suggest that osteoclastic activity leads to an increase in bone surface irregularity, which can be quantified by its fractal dimension. This makes fractal analysis by the box counting method a potential tool for the assessment of osteoclastic activity on bone surfaces in microscopic examination

Características clínico-patológicas do líquen plano bucal em pacientes diagnosticados em um único serviço de Medicina Oral no Brasil: um estudo descritivo

Lichen planusis a T-cell mediated mucocutaneous disease of um known etiology. Know ledgeon epidemiological data from the disease isimportantto preventand to establish therapeutics trategies. Objective: the aim of this study was to review cases diagnosed as oral lichen planus in a Stomatology service. Material and method: all cases diagnosed as oral lichen planus were reviewed and epidemiological data were obtained from the patients records. Demographic and clinical data were described, including gender, age, symptoms, time of evolution, medical history, habits, location and clinical aspect of the lesions. Clinical and histological analysis was performed using van der Waal´s parameters (van der Waal, 2009). Cases with incomplete data and without final conclusive diagnosis were excluded. Results: sixteen cases composed the final sample through both clinical and histological criteria. Females were more affected (94%) and mean age of the patients was 55 years-old (ranging from 24 to 82 years-old). The most common site of involvement was buccal mucosa.Most lesions (69%) were clinically described as white bilateral symmetric striae with erithematous areas. Most patients (75%) complained about burning symptoms. Medical history revealed 44% of the patients with hypertension, 12% of the patients with diabetes and 19% of the patients with hypothyroidism and 6% with hyperthyroidism. Six percent of the patients were smokers. Conclusion: oral lichen planus affected more middle age females with discrete signs and symptoms.Objetivo: o objetivo deste estudo foi revisar todos os casos diagnosticados como líquen plano bucal em um período de 11 anos em um serviço de estomatologia. Material e Métodos: todos os casos diagnosticados como líquen plano bucal foram revisados ??e dados epidemiológicos foram obtidos dos prontuários dos pacientes. Dados demográficos e clínicos foram descritos, incluindo sexo, idade, sintomas, histórico médico, hábitos, localização e aspecto clínico das lesões. A análise clínica e histológica foi realizada com o uso de van der Waal critérios (van der Waal, 2009). Casos com dados incompletos e sem diagnóstico conclusivo final foram excluídos. Resultados: dezesseis casos compuseram a amostra final através de critérios clínicos e histológicos. As mulheres foram mais afetadas (94%) e a média de idade dos pacientes foi de 55 anos (variando de 24 a 82 anos). O local mais comum de envolvimento foi a mucosa bucal. A maioria das lesões (69%) foi descrita clinicamente como estrias simétricas bilaterais brancas com áreas eritematosas. A maioria pacientes (75%) queixaram-se de sintomas de queimação. A história médica revelou 44% dos pacientes com hipertensão arterial, 12% dos pacientes com diabetes e 25% dos pacientes com disfunção tireoidiana. Conclusões: o LPO afetou principalmente as fêmeas adultas e as lesões afetaram preferencialmente a mucosa bucal, língua e gengiva mucosa alveolar. A maioria dos pacientes apresentava outras comorbidades médicas, mas sua associação com o LPO deveria ser mais investigada

Fibroma ossificante periférico de grandes dimensões simulando clinicamente uma neoplasia maligna

Objective: the aim of the present paper is to report a large peripheral ossifying fibroma (POF) clinically mimicking a malignant neoplasm. Case report: a 35 yearold female was referred for evaluation of a 6,0 x 4,0 cm reddish partially ulcerated and bleeding exophytic swelling situated in the upper left gingiva and alveolar mucosa, lasting 3 months. Panoramic and occlusal radiographs showed no alterations and computed tomograph scans showed the presence of calcified foci inside the lesion. Clinical diagnosis was peripheral ossifying fibroma and bone-producing neoplasms, including osteosarcoma. An incisional biopsy under local anesthesia was performed and the 5 ?m HE-stained sections revealed a homogeneous proliferation of spindle cells associated with areas of calcified tissue and covered by partially-ulcerated surface epithelium. Conservative complete surgical removal of the lesion was performed and analysis of the surgical specimen confirmed the histological features from the initial biopsy and the diagnosis of peripheral ossifying fibroma. Clinical follow-up showed the area totally repaired and no evidence of local recurrence. Conclusion: malignant neoplasms can be eventually included in the differential diagnosis of oral reactive inflammatory conditions and histological analysis is essential for proper diagnosis and management.Objetivo: O objetivo do presente trabalho é relatar um fibroma ossificante periférico de grandes dimensões simulando clinicamente uma neoplasia maligna. Relato de caso: paciente de 35 anos, sexo feminino, foi encaminhada para avaliação de lesão exofítica, medindo 6,0 x 4,0 cm parcialmente ulcerada, avermelhada e sangrante, localizada na gengiva e mucosa alveolar superior a esquerda, com duração de 3 meses. Radiografias panorâmica e oclusal superior não mostraram alterações significativas e na tomografia computadorizada foram observadas calcificações no interior da lesão. O diagnóstico clínico incluiu Fibroma ossificante periférico e neoplasias produtoras de tecido mineralizado, incluindo osteossarcoma. Foi realizada biópsia incisional sob anestesia local e cortes de 5 µm corados com hematoxilina e eosina evidenciaram uma proliferação homogênea de células fusiformes associadas a áreas focais de calcificação coberta por epitélio de superfície parcialmente ulcerado. A remoção cirúrgica total da lesão realizada de forma conservadora sob anestesia local confirmou os achados histológicos encontrados no espécime da biopsia incisional e o diagnóstico de fibroma ossificante periférico. O controle clínico pós-cirúrgico mostrou a área totalmente cicatrizada e sem evidências de recidiva. Conclusão: neoplasias malignas podem eventualmente ser incluídas no diagnóstico diferencial clínico e imaginológico de condições inflamatórias reativas da cavidade oral e a avaliação histológica é mandatória para a confirmação diagnóstica