Bilateral maxillary osteoplasty with esthetic purpose in patient with secondary hyperparathyroidism-related brown tumor: case report

To report a case of a patient with secondary hyperparathyroidism that developed brown tumour in bilateral maxilla surgically managed with bilateral osteoplasty for aesthetic reasons. Case report: A 46 years-old woman patient with chronic kidney disease with complain of a painless bilateral growth on the maxilla, beginning 10 years before that ceased after surgical removal of the parathyroid eight years before. A CT scan showed a diffuse and heterogeneous bone lesion, with lytic areas and increased multilobulated volume on the maxilla, bilaterally. The surgery was an osteoplasty of the maxilla bone and performed under general anaesthesia. At 16-month follow-up, no recurrence was observed and the patient is satisfied with aesthetic and functional results. Conclusion: Secondary hyperparathyroidism related with oral brown tumour is a rare condition that affects function and aesthetic. The case reported in this paper was appropriately managed, achieving patient expectation and improving her life quality

Implantes dentários em pacientes usuários de bifosfonatos: o risco de osteonecrose e perda dos implantes é real? Relato de três casos clínicos Dental implants in patients under bisphosphonate therapy: is the risk of osteonecrosis of the jaw and implant loss real? Report of three clinical cases

Introdução: A osteonecrose induzida por medicamentos (ONIM) é uma grave complicação da terapia com drogas antirreabsortivas, como os bifosfonatos (BFs). Embora ocorra com mais frequência em pacientes oncológicos, os quais utilizam BFs endovenosos, pacientes usuários de BFs orais para tratamento de osteoporose também se encontram no grupo de risco, principalmente quando procedimentos odontológicos cirúrgicos como exodontias e implantes dentários são realizados. Objetivo: Relatar três casos de pacientes que fizeram usode BFs no passado ou ainda utilizavam a medicação durante cirurgia para instalação de implantes dentários, abordando os principais fatores de risco para o desenvolvimento da ONIM. Conclusão: O conhecimento prévio pelo implantodontista dos efeitos adversos da terapia com drogas antirreabsortivas em pacientes que necessitam de reabilitação dentária é de extrema importância no manejo desses pacientes, uma vez que elas podem prejudicar a longevidade das reabilitações com implantes e induzir à osteonecrose dos maxilares,comprometendo não somente a saúde bucal como também interferindo negativamente na qualidade de vida dos pacientes.Introduction: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious complication of therapies with anti-resorptive drugs, such as bisphosphonates (BFs). Although it occurs more often in oncology patients who use intravenous BFs, patients who use oral BFs for osteoporosis are also in the risk group, especially when surgical dental procedures such as dental extraction or dental implants are performed. Objective: To report three cases of patients who were submitted to BF therapy in the past or were still using the medication during dental implants surgery and developed BRONJ and lost the implants. Conclusion: It is extremely important that the dentists are aware of the adverse effects of BF therapy in patients that require dental rehabilitation for the management thereof, since they can reduce the longevity of dental implants and induce osteonecrosis of the jaw, compromising not only their oral health but also these patients’ quality of life.Introdução: A osteonecrose induzida por medicamentos (ONIM) é uma grave complicação da terapia com drogas antirreabsortivas, como os bifosfonatos (BFs). Embora ocorra com mais frequência em pacientes oncológicos, os quais utilizam BFs endovenosos, pacientes usuários de BFs orais para tratamento de osteoporose também se encontram no grupo de risco, principalmente quando procedimentos odontológicos cirúrgicos como exodontias e implantes dentários são realizados. Objetivo: Relatar três casos de pacientes que fizeram usode BFs no passado ou ainda utilizavam a medicação durante cirurgia para instalação de implantes dentários, abordando os principais fatores de risco para o desenvolvimento da ONIM. Conclusão: O conhecimento prévio pelo implantodontista dos efeitos adversos da terapia com drogas antirreabsortivas em pacientes que necessitam de reabilitação dentária é de extrema importância no manejo desses pacientes, uma vez que elas podem prejudicar a longevidade das reabilitações com implantes e induzir à osteonecrose dos maxilares,comprometendo não somente a saúde bucal como também interferindo negativamente na qualidade de vida dos pacientes.Introduction: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious complication of therapies with anti-resorptive drugs, such as bisphosphonates (BFs). Although it occurs more often in oncology patients who use intravenous BFs, patients who use oral BFs for osteoporosis are also in the risk group, especially when surgical dental procedures such as dental extraction or dental implants are performed. Objective: To report three cases of patients who were submitted to BF therapy in the past or were still using the medication during dental implants surgery and developed BRONJ and lost the implants. Conclusion: It is extremely important that the dentists are aware of the adverse effects of BF therapy in patients that require dental rehabilitation for the management thereof, since they can reduce the longevity of dental implants and induce osteonecrosis of the jaw, compromising not only their oral health but also these patients’ quality of life

Brazilian minipig as a large-animal model for basic research and stem cell-based tissue engineering. Characterization and in vitro differentiation of bone marrow-derived mesenchymal stem cells

Stem cell-based regenerative medicine is one of the most intensively researched medical issues. Pre-clinical studies in a large-animal model, especially in swine or miniature pigs, are highly relevant to human applications. Mesenchymal stem cells (MSCs) have been isolated and expanded from different sources. Objective: This study aimed at isolating and characterizing, for the first time, bone marrow-derived MSCs (BM-MSCs) from a Brazilian minipig (BR1). Also, this aimed to validate a new large-animal model for stem cell-based tissue engineering. Material and Methods: Bone marrow (BM) was aspirated from the posterior iliac crest of twelve adult male BR1 under general anesthesia. MSCs were selected by plastic-adherence as originally described by Friedenstein. Cell morphology, surface marker expression, and cellular differentiation were examined. The immunophenotypic profile was determined by flow cytometry. The differentiation potential was assessed by cytological staining and by RT-PCR. Results: MSCs were present in all minipig BM samples. These cells showed fibroblastic morphology and were positive for the surface markers CD90 (88.6%), CD29 (89.8%), CD44 (86.9%) and negative for CD34 (1.61%), CD45 (1.83%), CD14 (1.77%) and MHC-II (2.69%). MSCs were differentiated into adipocytes, osteoblasts, and chondroblasts as demonstrated by the presence of lipidic-rich vacuoles, the mineralized extracellular matrix, and the great presence of glycosaminoglycans, respectively. The higher gene expression of adipocyte fatty-acid binding protein (AP2), alkaline phosphatase (ALP) and collagen type 2 (COLII) also confirmed the trilineage differentiation (

Evaluation of the bone-implant contact in the mandible of irradiated minipigs and the use of mesenchymal stem cells associated with platelet-rich plasma on osseointegration

Introdução: Pacientes com câncer na região de cabeça e pescoço normalmente são tratados por combinação de cirurgia, radioterapia (RT) e quimioterapia. Em muitos casos, a reabilitação oral com próteses implanto-suportadas representa a melhor opção para uma recuperação funcional adequada. Entretanto, em pacientes irradiados procedimentos como exodontias e instalações de implantes dentários são fatores de risco ao desenvolvimento de osteorradionecrose. Diversos estudos experimentais têm demonstrado que o uso de células-tronco mesenquimais (CTMs) associadas a fatores de crescimento como plasma rico em plaquetas (PRP) proporciona melhora no reparo ósseo e na osseointegração, podendo ser considerada uma alternativa viável para defeitos ósseos ou injúria. Objetivos: Isolar e caracterizar as CTMs da medula óssea (MO) de miniporcos brasileiros (Minipigs BR-1), avaliar a interferência da RT e o efeito da associação de CTMs-MO+PRP no processo de osseointegração de implantes instalados em alvéolos frescos em mandíbulas de miniporcos, por análise histológica e histomorfométrica da interface osso-implante. Métodos: CTMs-MO de 12 miniporcos adultos machos foram isoladas da crista ilíaca. Após 21 dias de cultura, o potencial de diferenciação celular foi avaliado por meio de coloração e RT-PCR. O perfil imunofenotípico foi caracterizado por citometria de fluxo. Os animais foram divididos em três grupos: Grupo A (grupo controle, sem RT), Grupo B (implantes instalados 15 dias antes da RT) e Grupo C (implantes instalados três meses após a RT). A dose total de radiação para cada lado da mandíbula foi de 24 Gy, divididos em três doses de 8 Gy com intervalo de 7 dias entre as doses, a qual equivale biologicamente a aproximadamente 56 Gy, com 28 exposições de 2 Gy cada. Quatro implantes de titânio foram instalados nos alvéolos frescos, imediatamente após as extrações dos terceiro e quarto pré-molares, totalizando 48 implantes controles e 48 experimentais (uso de CTM-MO+PRP). Os animais foram eutanasiados 90 dias pós-implantação. Foram analisados o percentual de implantes perdidos (PIP), o contato osso-implante (COI), e a densidade óssea no interior das roscas (DOIR). Resultados: A eficiência de isolamento das CTMs-MO foi de 100% e em cultura as células apresentaram morfologia fibroblastóide. As células foram positivas para CD90 (88,6%), CD29 (89,8%), CD44 (86,9%) e negativas para CD34 (1,6%), CD45 (1,8%), CD14 (1,8%) e MHC-II (2,7%). As células foram diferenciadas em adipócitos, demonstrado pela presença de vacúolos lipídicos no interior das células; osteoblastos, pela mineralização da matriz extracelular e condrócitos pela presença de lacunas ao redor dos condrócitos jovens. A maior expressão gênica de AP2, ALP e COL II em células induzidas também confirmou o potencial de diferenciação (p < 0,001; p < 0,001; p = 0,031; respectivamente). Os PIP nos lados controle e experimental foram respectivamente 25,0% e 18,7% no grupo A (p = 0,686), 31,2% e 25,0% no grupo B (p=0,686) e 68,7% e 68,7% no grupo C (p =1,000). Na comparação entre os três grupos, o PIP apresentou diferença estatisticamente significante tanto no lado controle (p=0,041) como no experimental (p = 0,047). Os percentuais de COI nos lados controle e experimental foram respectivamente 39,0 e 27,7 no grupo A (p = 0,110); 20,9 e 16,7 no grupo B (p=0,347) e 16,0 e 7,1 no grupo C (p = 0,310), com diferença estatística entre os grupos tanto no lado controle (p = 0,033) quanto no experimental (p=0,046). As DOIR nos lados controle e experimental foram respectivamente 46,8 e 36,5 no grupo A (p = 0,247); 29,3 e 24,1 no grupo B (p = 0,379) e 21,0 e 11,6 no grupo C (p = 0,421), porém com diferença estatisticamente significante entre os três grupos somente no lado controle (p=0,025). Conclusões: As CTMs-MO de Minipigs BR-1, obtidas com o protocolo utilizado neste estudo são células-tronco, podendo ser aplicadas em ensaios pré-clínicos na medicina regenerativa. Os resultados mostraram um efeito negativo da radiação ionizante na neoformação óssea periimplantar tanto no grupo B quanto no C. Após a RT a perda de implantes foi três vezes maior que em osso não irradiado. A RT realizada 15 dias após a instalação dos implantes não interferiu na perda de implantes, sugerindo que este seria o melhor momento para reabilitação bucal com implantes dentários. Com a metodologia empregada, o uso da associação CTMs-MO+PRP previamente à instalação de implantes não apresentou efeito positivo significante na neoformação óssea periimplantarIntroduction: Patients with head and neck cancer are usually treated by a combination of surgery, radiotherapy (RT) and chemotherapy. In many cases, oral rehabilitation with implant-supported prostheses is the best option for a proper functional recover. However, in irradiated patients procedures as dental extractions and implants are risk factors for developing osteoradionecrosis. Several experimental studies have shown that the use of mesenchymal stem cells (MSCs) associated with growth factors such as platelet-rich plasma (PRP) provides improvement in bone regeneration and osseointegration, being considered an alternative to bone defects or injury. Objectives: To isolate and characterize MSCs from bone marrow (BM) of Brazilian minipigs (Minipigs BR-1), to evaluate the effect of RT and of BM-MSCs+PRP in the osseointegration of implants placed in fresh sockets, by histological and histomorphometric analysis of the bone-implant interface. Methods: BM-MSCs from 12 adult male minipigs were isolated from the iliac crest. After 21 days of culture, cell differentiation potential was assessed by staining and RT-PCR. The immunophenotypic profile was characterized by flow cytometry. The animals were divided into three groups: Group A (control group, no RT), Group B (implants placement 15 days before RT) and Group C (implants placement three months after RT). The total radiation dose for each side of the mandible was 24 Gy, divided into 3 doses of 8 Gy with a 7 dayinterval for each dose, which is biologically equivalent to approximately 56 Gy, with 28 sections of 2 Gy each. Four titanium implants were installed in the alveoli fresh, immediately after the extraction of the third and fourth premolars of each hemimandible, totalling 48 implants on the control side and 48 on the experimental side (using BM-MSCs+PRP). The animals were euthanized 90 days post-implantation. The implant loss rate (ILR), the bone-implant-contact (BIC) and bone density inside the threads (BDIT) were determined in each group. Results: The efficiency of the isolation of BM-MSCs was 100%, and in culture, the cells showed fibroblastoid morphology. Cells were positive for CD90 (88.6%), CD29 (89.8%), CD44 (86.9%) and negative for CD34 (1.6%), CD45 (1.8%), CD14 (1.8%) and MHC-II (2.7%). Cells were differentiated into adipocytes, as demonstrated by the presence of lipid vacuoles in the cells, osteoblasts, by mineralization of extracellular matrix and chondrocytes, by the presence of gaps around the young chondrocytes. The higher gene expression of AP2, ALP and COL II at induced cells also confirmed the differentiation potential (p < 0.001, p < 0.001, p=0.031; respectively). The ILR in control and experimental sides were respectively 25.0% and 18.7% in group A (p=0.686), 31.2% and 25.0% in group B (p = 0.686) and 68.7% and 68.7% in group C (p =1.000), with a statistically significant difference between the three groups at the control side (p = 0.041) and at the experimental side (p = 0.047). The percentage of BIC in control and experimental sides were respectively 39.0 and 27.7 in group A (p = 0.110), 20.9 and 16.7 in group B (p = 0.347) and 16.0 and 7.1 in group C (p = 0.310), with statistical significance between the groups at the control side (p = 0.033) and at the experimental side (p = 0.046). The BDIT in experimental and control sides were respectively 46.8 and 36.5 in group A (p = 0.247), 29.3 and 24.1 in group B (p = 0.379) and 21.0 and 11.6 in group C (p = 0.421), with statistical significance between the three groups only at the control side (p = 0.025). Conclusions: The BM-MSCs of Minipigs BR-1 obtained with this protocol can be used in pre-clinical regenerative medicine since they are stem cells. The results showed a negative effect of RT in peri-implant bone regeneration in group B and C. The implant loss was three times higher in irradiated bone than in non-irradiated one. The RT performed 15 days after implant placement did not interfere with implant loss, suggesting that this would be the best time for oral rehabilitation with dental implants. With this methodology, the use of BM-MSCs+PRP before the implant placement did not show any significant positive effect on peri-implant bone regeneratio

Clinical assessment of oral mucositis and candidiasis compare to chemotherapic nadir in transplanted patients

Oral mucositis is a chief complication in patients undergoing hematopoietic stem cell transplantation (HSCT). It is considered a toxic inflammatory reaction that interferes with the patient&#8217;s recuperation and quality of life. Oral candidiasis is a common fungal infection observed in dental practice, particularly in immunocompromised patients. The aim of this study was to evaluate the presence of oral mucositis and oral candidiasis in patients who underwent HSCT and their correlation with the chemotherapeutic nadir (lowest possible outcome). We evaluated patients with different diagnoses who underwent HSCT at the Hospital Erasto Gaertner. No chemotherapeutic nadir curves could be associated with mucositis, and patients had different presentations of mucositis. No patient developed oral candidiasis during hospitalization. Together with cell counts, we collected demographic data including age, oral hygiene, habits harmful to health, and the use of oral prostheses. It was observed that patients who smoked cigarettes before hospitalization showed less mucositis, resulting in no feeding problems or other comorbid conditions due to the effect of mucositis. However, the nadir of the chemotherapy curve, in isolation, is not a predictive tool for the appearance (or no appearance) of oral mucositis