Propriedades inflamatorias da placa dental e de alguns de seus componentes

Tese (livre-docente) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaAcompanha memorialResumo: Está bem fundamentada a relação entre placa dental e doença periodem tal inflamatória. Entretanto, devido à coraplexidade da estrutura da placa ainda não se sabe quais as bactérias ou substâncias diretamente envolvidas no processo. Como as bactérias normalmente não atravessam a barreira epitelial, a atenção tem sido voltada para os componentes da placa que têm possibilidade de atingir o tecido conjuntivo subjacente. No presente trabalho foi utilizado como modelo experimental a cavidade peritonial de camundongos, que se mostrou eficiente para o estudo das propriedades inflamatórias da placa dental e de alguns de seus componentes. Inicialmente foi feito um estudo comparativo da capacidade da placa dental e de alguns de seus componentes em provocar migração leucocitária , extravasamento de material plasmático (complemento, albumina e imunoglobulinas), e aumento da fagocitose de macrofagos . A fração preparada da placa dental foi ativa neste sistema, e o tratamento com hidróxido de sódio diminuiu suas propriedades inflamatórias. Das substâncias isoladas, as mais potentes foram o lipopolissacarídio da Veillonela alcalescens, o Mutano I (com mais de 99% de ligações a -1 - 3) , a fração solúvel do Actinomyces viscosus e o Lipídio A, enquanto que o Dextrano T-250 , o Mutano II (90% de a-1-3 e 10% a-1-6) , o Acido Lipoteicoico e o Levano tiveram pouca atividade neste sistema. Procurou-se também estudar neste modelo, o efeito do pre-tratamento com lipopolissacarídio (LPS) na resposta inflamatoria. Camundongos pré - tratados intraperitonialmente com os lipopolissacarídeos da Salmonella typhimurium (S-LPS) e Escherichia coli (E-LPS) apresentaram resposta inflamatória aumentada quando o teste foi feito no peritônio, enquanto que os pré-tratados com LPS derivado da Veillonella alcalescens (V-LPS) apresentaram menor número de células, em relação aos controles, quando do desafio. Animais pré-tratados endovenosamente com S-LPS, E-LPS ou V-LPS mostraram maior número de mononucleares e polimorfonucleares, 24 horas após o desafio no peritônio com as mesmas substâncias. Os animais pré-tratados com E-LPS e S-LPS apresentaram células formadoras de anticorpos e anticorpos específicos no sangue e fluido peritonial. Com o V-LPS não foram observados resultados semelhantes. A participação das imunoglobulinas nas reações inflamatórias causadas pelo LPS foi estudada através da transferência passiva de anticorpos.Abstract: J.t is well established that dental plaque plays a fundamental role in the pathogenicity of the inflammatory periodental disease. Nevertheless, the composition of dental plaque is so complex .that until now it is not "known which bacteria or substances are involved in this disease. As the microorganisms cannot, cross the epithelial harrier, attention has been focused on the extracellular metabolites present in plaque, which could directly damage the periodontal connective tissue. In this work the peritoneal cavity of mice was used to study the inflammatory properties of dental plaque and some of its components. Initially a comparative study of the capacity of dental plaque and its constituents to provoke leukocyte migration, plasma extravasation (complement, albumine and immunoglobulines ) , and macrophage activation was made. The dental plaque material was active in this system, and deacetylation with sodium hydroxide decreased its inflammatory properties. Of the isolated substances, the more powerful to elicit an inflammatory response were the lipopolysaccharide from Veillonella alcalescens, Mutan I (more than 99% a-1-3 linkages ) , a soluble extract from Actinomyces viscosus and Lipid A, while Dextran T-2S0, Mutan II (90% a-1-3 and 10% a-l-6 linkages), Lipoteichoic acid and Levan had only a small activity in this model. The effect of pre-treatment of mice with LPS in the inflammatory response was also studied. Mice injected intravenously ou intraperitoneally with LPS derived from Salmonella typhimurium (S-LPS), Escherichia coli (E-LPS) or Veillonella alcalescens (V-LPS) had an increased leukocyte response, when inflammation was induced in the peritoneal cavity with the same substances. The only exception was V-LPS which when injected in the peritoneal cavity caused a chronic inflammation, and a decreased response when the test was done in the peritoneal cavity itself. The pre-treatment with E-LPS and S-LPS, induced the formation of plaque forming cells in the spleen, as well as the presence of specific antibodies in the blood and peritoneal fluid, but this response was not observed with V-LPS. To verify the participation of immunoglobulines in these reactions, we used the passive transfer of antibodies, which also provoked an increased inflammatory response.Livre DocênciaLivre docente em Biologia e Patologia Buco-Denta

Mixed odontogenic tumors: A review of the clinicopathological and molecular features and changes in the WHO classification

Ameloblastic fibromas and ameloblastic fibrosarcomas are rare odontogenic tumors, and controversy exists in the classification of cases presenting hard-tissue production: Ameloblastic fibrodentinoma (AFD) and ameloblastic fibro-odontoma (AFO). These cases are currently considered “developing odontomas” (hamartomatous lesions). To analyze the clinicopathologic features of these lesions and discuss the changes in the 2017 World Health Organization classification

Intraoral Sialadenoma Papilliferum: A Comprehensive Review of the Literature with Emphasis on Clinical and Histopathological Diagnostic Features

Sialadenoma papilliferum (SP) is a rare benign epithelial tumor of salivary gland origin, its diagnosis being potentially challenging. It was first described by Abrams and Finck in 1969 as an analog of the cutaneous syringocystadenoma papilliferum. The aim of this comprehensive review is to highlight the clinical and histopathological diagnostic aspects of intraoral SP, analyzing cases previously described and reporting new cases. Methods. Medline, Scopus, and Web of Science were searched up to February 2022, using as entry term “sialadenoma papilliferum”. No time limits were applied and only studies in English were taken into account. Only cases involving the mouth were included. Conference proceedings, personal communications, and letters to the editor were excluded. Results. In total, 42 out of 234 articles fulfilled the inclusion criteria, with 64 cases reported. Mean age of patients with SP was 57.2 years, with a higher prevalence among males. The most affected site was the palate, particularly the hard palate. Four cases with uncertain malignant features have been reported. While clinical manifestations of SP are rather unspecific (e.g., submucosal swelling with ulceration), histopathological and immunohistochemical features are quite peculiar, SP have a limited growth potential, leading to conservative excision as treatment of choice. Conclusions. SP, though rare, should be taken into consideration in the differential diagnosis of intraoral swellings, particularly those located on the palate

Coronectomy - An alternative approach to remove impacted teeth in oncological patients

Coronectomy involves the section of the tooth crown leaving the roots in the socket. Possibility of inferior alveolar nerve injury and mandibular fracture are the main indications for this approach. Herein, we describe a case series of coronectomy to highlight its indication in normal and oncological patients. A total of 9 patients were submitted to coronectomy, 6 of them were oncological. Three patients were evaluated before head and neck radiotherapy (HNRT), 2 after HNRT and 1 before bone marrow transplantation. Mean age of the patients was 49 years, most of them male (n=7). Lower third molars were the main teeth that received this procedure, and all cases presented intimate anatomic relationship between the roots and the mandibular canal. Moreover, three cases also presented evident mandibular fracture risk in removing the tooth. During the follow-up period, none complications were observed related to coronectomy and oncological treatment. Coronectomy is a safe approach including for cancer patients and it should be considered in high-risk impacted teeth extractions

Extraskeletal myxoid chondrosarcoma of the masticator space in a pediatric patient

Extraskeletal myxoid chondrosarcoma (EMC) is a malignant soft-tissue neoplasm rarely described in the head and neck region of children and adolescents. We describe a case of EMC affecting the masticator space and a literature review. A 13-year-old boy who presented a large painless, diffuse mass causing progressive midfacial asymmetry of 6 months duration. Histopathological evaluation revealed a multinodular lesion, containing scattered round vacuolated tumor cells dispersed in an abundant myxoid stroma, separated by fibrous septae. Immunohistochemical analysis revealed positivity for vimentin, neuron-specific enolase, and chromogranin. The Ki-67 labelling index was 42%. The patient was treated surgically with tumor resection followed by adjuvant local radiotherapy. The patient died 1 year after initial diagnosis due to locoregional tumor dissemination. EMC should be considered in the differential diagnosis of myxoid neoplasms in the head and neck region

Tissue microarray construction for salivary gland tumors study

Objective: To describe and discuss the design, building and usefulness of tissue microarray (TMA) blocks for the study of salivary gland tumors (SGTs). Study Design: Two hundred thirty-eight formalin-fixed, paraffin-embedded SGTs were arranged in blocks of TMA using a manual tissue arrayer. Three representative cores of 1.0, 2.0 or 3.0mm were taken from each original block and their characteristics were analyzed and described. Results: It was created 12 TMA blocks that presented highly representative neoplastic cylinders. However, those neoplasias rich in cystic spaces such as mucoepidermoid carcinoma and Warthin tumor presented more difficulties to be sampled, as the neoplastic tissue available was scarce. Tissue damage and loss during TMA construction was estimated as 3.7%. Conclusion: Representative areas of SGTs, with relatively small loss of tissue, can be obtained with the construction of TMA blocks for molecular studies. However, tumors rich in cystic spaces present more difficulties to be adequately sampled

Clear cell variant of calcifying epithelial odontogenic tumor: case report with immunohistochemical findings

Calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic neoplasm, locally aggressive, characterized by sheets and nests of polyhedral epithelial cells exhibiting eosinophilic cytoplasm or less often clear cytoplasm. Additional features include nuclear pleomorphism without mitotic activity, concentric calcifications, and deposits of amyloid. Herein, we present an additional example of clear cell variant of CEOT occurring in a 25-year-old female. Microscopically, the tumor consisted on proliferation of epithelial cells with eosinophilic, clear vacuolated cytoplasm interspersed with focal areas of amyloid deposition. Tumor cells were immunopositive for AE1/AE3, CK14, CK19, ß-catenin, CD138, and p63

Peripheral developing odontoma in newborn. Report of two cases and literature review

Extra-osseous odontogenic tumors are rarely observed. However, it is widely accepted that the remains of odontogenic epithelium entrapped in the oral soft tissues may be a possible source for peripheral odontogenic tumors differentiation. Peripheral developing odontoma is considered exceptionally rare, since few similar cases are described in the English-related literature under diverse nomenclature, such as irregular eruption, ectopic tooth, ectopic soft-tissue mesiodens, ectopic odontoma and extra-osseous tooth germ. Previously reported cases invariably affected children and surgical exploration revealed tooth germs exclusively embedded in the soft tissue without bone involvement. Microscopically, all these cases exhibited developing tooth germs composed of ameloblasts, enamel matrix, odontoblastic layer, dentin and dental papilla and the morphological findings seem to depend on the developmental stage of each tooth germ at discovery. Thus, we believe that it is relevant to report two additional cases that were recently diagnosed in Brazil and Guatemala, focusing on their nomenclature, correct diagnosis and further treatment

Isolamento e caracterização de fibroblastos gengivais positivos para fosfatase alcalina de pacientes portadores de periodontite crônica e hiperplasia gengival medicamentosa

PURPOSE: To investigate the expression of alkaline phosphatase (ALP) activity in gingival fibroblasts from individuals with chronic periodontitis (CP) and drug-induced gingival hyperplasia (DGH) induced by diphenylhydantoin. METHODS: Gingival fragments were obtained from 13 patients (8 women and 5 men, from 22 to 74 years of age), with 4 fragments from clinically normal gingiva (NG), 5 from biopsy of periodontal pockets with CP, and 4 from DGH induced by diphenylhydantoin. Using an enzymatic digestion procedure, gingival cell suspensions containing ALP-positive fibroblasts were prepared without affecting ALP activity. Cytochemistry and histochemistry analyses were performed. RESULTS: Fibroblasts from NG presented low levels of ALP when compared to CP and DGH, which showed elevated and intermediate levels of ALP, respectively. Little cell proliferation was observed for fibroblasts from CP and DGH as compared to NG. However, the quantity of cells recovered from the subcultures was similar to the quantity recovered from the initial cell culture for the three sources. CONCLUSION: The expression of ALP is increased in CP and DGH, and fibroblasts in CP and DGH show low proliferation. This suggests that periodontal inflammation and diphenylhydantoin may influence ALP expression and human gingival fibroblast expansion. Other studies are necessary to better assess the importance of ALP in the development and progression of CP and DGH.OBJETIVO: Investigar a expressão da atividade de fosfatase alcalina (ALP) em fibroblastos gengivais de sujeitos com periodontite crônica (PC) e hiperplasia gengival medicamentosa (HGM) induzida por difenilhidantoína. METODOLOGIA: Os fragmentos gengivais foram obtidos de 13 pacientes (8 mulheres e 5 homens, 22 a 74 anos), sendo 4 fragmentos procedentes de gengiva clinicamente normal (GN), 5 de biópsias de bolsas periodontais com PC e 4 de HGM induzida pela difenilhidantoína. Através de digestão enzimática, suspensões de células gengivais foram preparadas contendo fibroblastos ALP-positivos sem afetar a atividade da enzima ALP. Análises citoquímica e histoquímica foram realizadas. RESULTADOS: Fibroblastos de GN apresentaram fraca positividade para ALP quando comparados com PC e HGM. PC e HGM exibiram níveis elevados e intermediários, respectivamente, de ALP. Observou-se menor proliferação celular na cultura de células em PC e HGM que em GN. Entretanto, a quantidade de células recuperadas das sub-culturas foi similar à quantidade recuperada na cultura inicial para as três linhagens. CONCLUSÕES: A expressão de ALP na PC e na HGM encontra-se aumentada e ocorre baixa proliferação de fibroblastos na PC e na HGM. Isto sugere que a inflamação periodontal e a difenilhidantoína podem influenciar a expressão de ALP e a multiplicação de fibroblastos gengivais humanos. Outros estudos são necessários para melhor avaliar a importância de ALP no desenvolvimento e na progressão de PC e HGM.545

Kohlschütter-Tönz Syndrome: report of an additional case

Kohlschütter-Tönz Syndrome is a rare disorder clinically characterized by amelogenesis imperfecta, epilepsy and progressive mental deterioration. We present an additional case of this syndrome of a nine year-old boy who was referred by pigmented teeth. The mental deterioration was associated with speech delay, impulsive behavior, attention-deficit/hyperactivity disorder, and learning problems. The physical examination revealed a reduction of lower third, slightly palpebral fissures, low ear and hair implantation, coarse hair and hypertrichosis. The intraoral examination showed alteration in teeth pigmentation diagnosed as amelogenesis imperfecta. Although rare, the present case report illustrates a syndrome that has dental anomalies and systemic alterations. It is important to re - cognize this syndrome as early as possible and paediatric dentist may contribute to the diagnosis and consequently to better manage the patients