Stromal myofibroblasts in focal reactive overgrowths of the gingiva

Focal reactive overgrowths are among the most common oral mucosal lesions. The gingiva is a significant site affected by these lesions, when triggered by chronic inflammation in response to microorganisms in dental plaque. Myofibroblasts are differentiated fibroblasts that actively participate in diseases characterized by tissue fibrosis. The objective of this study was to evaluate the presence of stromal myofibroblasts in the main focal reactive overgrowths of the gingiva: focal fibrous hyperplasia (FFH), peripheral ossifying fibroma (POF), pyogenic granuloma (PG), and peripheral giant cell granuloma (PGCG). A total of 10 FFHs, 10 POFs, 10 PGs, and 10 PGCGs from archival specimens were evaluated. Samples of gingival mucosa were used as negative controls for stromal myofibroblasts. Oral squamous cell carcinoma samples, in which stromal myofibroblasts have been previously detected, were used as positive controls. Myofibroblasts were identified by immunohistochemical detection of alpha smooth muscle actin (α-sma). Myofibroblast immunostaining was qualitatively classified as negative, scanty, or dense. Differences in the presence of myofibroblasts among FFH, POF, PG, and PGCG were analyzed using the Kruskal-Wallis test. Stromal myofibroblasts were not detected in FFH, POF, PG, or PGCG. Consequently, no differences were observed in the presence of myofibroblasts among FFH, POF, PG, or PGCG (p > 0.05). In conclusion, stromal myofibroblasts were not detected in the focal reactive overgrowths of the gingiva that were evaluated, suggesting that these cells do not play a significant role in their pathogenesis.

Cemental tear: a case report with nonsurgical periodontal therapy / Dilaceração cementária: relato de caso clínico com terapia periodontal não cirúrgica

PURPOSE: To report a case of cemental tear, a rare periodontal condition characterized by total or partial separation of the dental cementum, mainly addressing issues related to its diagnosis and treatment. CASE DESCRIPTION: A 50 years-old man sought dental assistance complaining of pain located in the mandibular left second premolar that showed a 4 mm probing depth with the presence of a foreign body in the distal gingival sulcus. Radiographic examination demonstrated a slight radiopaque fragment detached from the root. The fragment was removed without a periodontal flap. Histopathological examination was performed and evidenced the presence of a cementum fragment with cementum lamellae, cementocytes, and adhered periodontal ligament fibers, confirming the diagnosis of cemental tear. CONCLUSION: After a follow-up of 2 years, the nonsurgical periodontal therapy showed satisfactory clinical and radiographic outcome. Therefore, this approach should be a suitable and predictable treatment modality for the cemental tear.

OBJETIVO: Relatar um caso de dilaceração cementária, uma condição periodontal rara caracterizada pela separação total ou parcial do cemento dental, abordando principalmente aspectos relativos ao seu diagnóstico e tratamento. DESCRIÇÃO DO CASO: Um homem de 50 anos procurou assistência odontológica queixando-se de dor localizada no segundo molar inferior que apresentava profundidade de sondagem de 4 mm com presença de um corpo estranho no sulco gengival da face distal. O exame radiográfico demonstrou um fragmento radiopaco destacado da raiz. O fragmento foi removido sem cirurgia periodontal. O exame histopatológico demonstrou tratar-se de um fragmento de cemento com presença de lamelas cementárias, cementócitos e fibras do ligamento periodontal, confirmando o diagnóstico de dilaceração cementária. CONCLUSÃO: Após dois anos, o tratamento periodontal não cirúrgico demonstrou aspectos clínicos e radiográficos satisfatórios. Portanto, a terapia periodontal não cirúrgica pode ser uma modalidade de tratamento adequada e previsível para a dilaceração cementária.

Processos proliferativos não neoplásicos gengivais / Focal reactive overgrowths of the gingiva a review of the literature

A mucosa gengival pode desenvolver processos proliferativos não neoplásicos secundários ao processo inflamatório desencadeado pela ação de irritantes locais. Entre esses processos, destacam-se hiperplasia fibrosa focal, granu- loma piogênico, fibroma ossificante periférico e lesão periférica de células gigantes. 0 objetivo desta revisão foi abordar etiopatogenia, características clínicas, características histopatológicas, tratamento e prognóstico destas lesões, enfatizando a importância do conhecimento destes processos patológicos para a prática clínica odontológica.