Mast cells in oral lichen planus and oral lichenoid lesions related to dental amalgam contact

Abstract The aim of this study was to analyze the expression of mast cell markers toluidine blue, c-kit, and tryptase and presence of mononuclear inflammatory cells in oral lichen planus (OLP) and oral lichenoid lesions related to dental amalgam. Nineteen specimens of OLP, OLLC, and healthy oral mucosa were selected. Mononuclear inflammatory cells were analyzed. Histochemical and immunohistochemical analyses were performed using toluidine blue, anti-c-kit and anti-tryptase reagents, and the results were quantified in areas A and B of connective tissue. Mast cells of all OLP and OLLC samples were positive for toluidine blue, c-kit, and tryptase. The density of toluidine blue+, c-kit+ and tryptase+ mast cells was higher in tissue with OLP and OLLC compared with healthy controls (p < 0.05). No difference was noted in mast cells density between OLP and OLLC (p > 0.05). The density of tryptase+ mast cells was higher in the subepithelial region (area A) than the region below it (Area B) in OLLC (p = 0.047). The mononuclear inflammatory cell density was higher in OLLC compared to OLP, but without statistical significance (p > 0.05). A positive statistical correlation was found between mononuclear immune cells and density of c-kit+ and tryptase+ mast cells in OLP (r = 0.943 and r = 0.886, respectively). Our data demonstrate that the etiopathogenesis process of OLP and OLLC modulates the expansion and degranulation of mast cells; mast cells density, however, was similar between OLP and OLLC. The distribution of mast cells appears to vary along the lamina propria.

Lip carcinoma mimicking keratoacanthoma: case reports / Carcinoma de lábio mimetizando queratoacantoma: relato de casos

ABSTRACT Oral amyloidosis is a disease characterized by extracellular and irreversible deposition of amorphous and fibrillar proteins in the oral cavity, being strongly associated with Multiple Myeloma. The objective of this study is to report a case of a 62-year-old woman diagnosed with Multiple Myeloma who, approximately 2 years after starting treatment for the underlying disease, presented a lesion on the lateral border of the tongue with exophytic growth, pinkish color, vascularized, painless, measuring 3cm in its largest diameter. After histopathological analysis through incisional biopsy, a final diagnosis of amyloidosis was obtained. As a local treatment, we opted for complete excision of the lesion. The patient evolved to death due to Multiple Myeloma influenced by the diagnosis of systemic amyloidosis. Oral amyloidosis is usually associated with the systemic presentation of the disease, making it necessary to conduct a thorough investigation of other organs. Its diagnosis is important since the prognosis is directly related and can negatively influence survival rates and treatment of the underlying disease.

RESUMO A amiloidose oral é uma doença caracterizada pela deposição extracelular e irreversível de proteínas amorfas e fibrilares na cavidade bucal, sendo fortemente associada com Mieloma Múltiplo. O objetivo deste trabalho é relatar o caso de uma mulher com 62 anos de idade diagnosticada com Mieloma Múltiplo que, aproximadamente 2 anos após o início do tratamento para a doença de base, apresentou lesão em borda lateral de língua com crescimento exofítico, de coloração rósea, vascularizada, indolor, medindo 3 cm em seu maior diâmetro. Após análise histopatológica através de biópsia incisional, obteve-se diagnóstico final de amiloidose. Como tratamento local, optou-se pela exérese completa da lesão. A paciente evoluiu para óbito por consequência do Mieloma Múltiplo com complicações associadas à amiloidose sistêmica. A amiloidose oral geralmente está associada com a apresentação sistêmica da doença, tornando necessária uma investigação aprofundada nos demais órgãos. Seu diagnóstico é importante uma vez que pode influenciar diretamente no prognóstico e, consequentemente, negativamente nas taxas de sobrevida e no tratamento da doença de base.

Prótese e implante sobre enxerto alógeno: análise histológica e acompanhamento clínico: radiográfico por 8 anos / Prosthesis and implant on allogenic graft: histological analysis and clinical: radiographic follow-up for 8 years

Este relato de caso clínico tem como objetivo descrever a utilização de osso alógeno na reconstrução de maxila atrófica para posterior reabilitação com prótese fixa metalocerâmica sobre implantes, fazer uma análise histológica do tecido ósseo enxertado e descrever o acompanhamento clínico e radiográfico por 8 anos. Uma paciente de 54 anos, com edentulismo parcial e atrofia moderada-a-severa na maxila, apresentou-se para tratamento demonstrando muito interesse em receber prótese sobre implantes. Após exame clínico e radiográfico, foi realizada montagem dos modelos de estudo em ASA para enceramento diagnóstico e obtenção de um guia multifuncional (tomográfico/ cirúrgico). A tomografia indicou a necessidade de reconstrução óssea maxilar. Procedeuse então à aposição de blocos de osso alógeno para aumento horizontal nas regiões anterior e posterior da maxila. Um dos blocos foi triturado e utilizado para levantamento do assoalho do seio maxilar no lado esquerdo. Dez meses depois, uma nova tomografia foi solicitada, utilizando o mesmo guia inicial, e os implantes instalados, utilizando o guia multifuncional como guia cirúrgico. Neste momento, material ósseo foi coletado na interface osso enxertado/osso nativo com uma broca trefina. Os resultados histológicos demonstraram viabilidade das células ósseas no enxerto, além da presença de vasos sanguíneos. Após o tempo necessário para osseointegração, procedeu-se com tratamento protético. Nenhuma complicação foi relatada até oito anos de controle. A sequência de tratamento proposta forneceu bons resultados estéticos e funcionais. Concluiu-se, então, que o emprego de osso alógeno é uma alternativa viável para a reconstrução de rebordos alveolares severamente reabsorvidos(AU)

This clinical case report aims to describe the use of allogeneic bone in the atrophic maxilla reconstruction for subsequent rehabilitation with a fixed metal-ceramic prosthesis on implants; to perform a histological analysis of the grafted bone tissue; and to describe the clinical and radiographic monitoring for 8 years. A 54-year-old patient, with partial edentulism and moderate-to-severe atrophy in the maxilla showed great interest in receiving implant prostheses. After c linical and radiographic examination, the ASA study models were assembled for diagnostic waxing and a multifunctional guide (tomographic / surgical) was obtained. Tomography indicated the need for maxillary bone reconstruction. Allogeneic bone blocks were then placed for horizontal enlargement in the anterior and posterior regions of the maxilla. One of the blocks was crushed and used to lift the floor of the maxillary sinus on the left side. Ten months later, a new tomography was requested, using the same initial guide, and the implants installed, using the multifunctional guide as a surgical guide. At this time, bone material was collected at the grafted bone / native bone interface with a trephine drill. Histological results demonstrated viability of bone cells in the graft, besides the presence of blood vessels. After the necessary time for osseointegration, a prosthetic treatment was performed. No complications were reported up to eight years of control. The propose treatment sequence provided good aesthetic and functional results. It was concluded, then, that the use of allogeneic bone is a viable alternative for the reconstruction of severely reabsorbed alveolar edges(AU)

Oral metastasis intraosseous mimicking periapical lesion: a case report / Metástase oral intraóssea mimetizando lesão periapical: um relato de caso

ABSTRACT Jaw metastasis can be mistaken for inflammatory or infectious diseases. Then, they should be considered in the differential diagnosis of unknown jaw lesions. Study reported here involved metastasis of breast cancer in the mandible of a 45-year-old woman. The most important differential diagnostic was a reactive lesion in an unusual periapical location associated with a nonvital tooth. However, given patient's medical history and because paresthesia and pain were observed a few days after pulpectomy, metastasis of breast cancer could not be ruled out. When bone scintigraphy suggested the metastasis of a malignant bone tumor, incisional biopsy was performed. Histopathologic examination and immunohistochemical reaction confirmed the diagnosis of metastasis of breastcancer, and chemotherapy was thus performed as well. Unfortunately, patient died 2 years after diagnosis. Dentists as well as general physicians should therefore consider presence of oral metastasis in cases involving atypical symptoms, especially in patients with known malignant disease.

RESUMO As metástases mandibulares podem ser confundidas com doenças inflamatórias ou infecciosas. Sendo assim, elas devem ser consideradas no diagnóstico diferencial de lesões desconhecidas na mandíbula. Esse relato de caso envolveu metástase de câncer de mama na mandíbula de uma mulher de 45 anos. O diagnóstico diferencial mais importante foi uma lesão reacional, em uma localização periapical incomum, associada a um dente não vital. No entanto, dado o histórico médico da paciente e uma vez que parestesia e dor foram observadas alguns dias após a realização da pulpectomia, a metástase de câncer de mama não foi descartada. Quando a cintilografia óssea sugeriu a metástase de um tumor ósseo maligno, uma biópsia incisional foi realizada. O exame histopatológico e a reação imunohistoquímica confirmaram o diagnóstico de metástase do câncer de mama, e a quimioterapia foi então realizada. Infelizmente, a paciente morreu 2 anos após o diagnóstico. Portanto, dentistas e médicos generalistas devem considerar a presença demetástases oral em casos que envolvam sintomas atípicos, principalmente em pacientes com doença maligna conhecida.

Mast cell degranulation in periodontal disease from HIV-infected individuals

Aim: The objective was to compare the density and degranulation of mast cells on specimens obtained from individuals diagnosed with gingivitis or chronic periodontitis who were either non-HIV-infected or HIV-infected patients treated with highly active antiretroviral therapy (HAART). Methods: Gingival samples were taken from 16 non-HIV-infected individuals and 17 HIV-infected individuals diagnosed with gingivitis and chronic periodontitis. The samples were processed and tained with 0.3 percent o-toluidine blue. Densities (cells/mm²) and percentages of intact and degranulated mast cells were obtained. Results: No statistically significant differences were observed in the mast cell density and the percentage of degranulated mast cells between non-HIV-infected and HIV-infected individuals diagnosed with gingivitis and chronic periodontitis. Mononuclear inflammatory infiltrate was weakly correlated with the percentage of mast cells degranulated for both groups. Conclusions: There are no differences of the density and degranulation of mast cells in gingival tissue between non-HIV-infected and HIV-infected patients undergoing HAART, both groups with diagnosis of gingivitis or chronic periodontitis. This may be a result of the recovery of the immunologic system by HAART treatment.

Relações entr / Relation between cytokines, chemokines, and maturation of dendritic cells, in smokers and non-smokers, diagnosed with chronic periodontitis

A periodontite crônica (PC) é a principal forma de doença periodontal destrutiva e resulta da interação entre bactérias e resposta inflamatória do hospedeiro, podendo ser afetada por fatores ambientais como o fumo. o objetivo do estudo foi avaliar a expressão de citocinas e quimiocinas, assim como a densidade de células dendríticas (CDs) imaturas e maduras, e densidade do infiltrado inflamatório no tecido gengival de indivíduos não-fumantes (NF) e fumantes (F), diagnosticados com periodontite crônica. O estudo foi aprovado pelo COEP-UFMG (423/11) e foram recrutados 24 indivíduos NF e 21 F...

Morphometric evaluation of keratocystic odontogenic tumor before and after marsupialization

The aim of the present study was the morphometric evaluation of the epithelial lining and fibrous capsule in histological specimens of keratocystic odontogenic tumors (KOTs) before and after marsupialization. Histological sections from six KOTs that had undergone marsupialization followed by enucleation were photographed. The thickness and features of the capsule and of the epithelial lining of the tumor were evaluated upon marsupialization and upon subsequent enucleation using Axion Vision software. The histological specimens taken upon marsupialization presented an epithelial lining that is typical of KOTs. After marsupialization, the enucleated specimens had a modified epithelial lining and a fibrous capsule that both presented a greater median thickness (p = 0.0277 and p = 0.0212, respectively), morphological changes, and significant enlargement. These modifications can facilitate full surgical treatment and may well be related to a low KOT recurrence rate.

Uso de enxerto ósseo alógeno para aumento vertical e horizontal em pacientes parcialmente edêntulos na maxila: relato de caso com análise microscópica após dez meses, e dois anos de acompanhamento após a instalação da prótese / The use of allogeneic bone grafts for horizontal and vertical augmentation in partially edentulous maxillary sites: case report with histological analysis after ten months and two-years of clinical follow-up with definitive prosthesis

Este relato de caso descreve o uso de enxertos ósseos alógenos para aumento horizontal e vertical na região maxilar. Uma paciente de 54 anos de idade apresentou-se com edentulismo parcial e atrofia moderada-severa entre as regiões 12 e 26. Após análise por TCFC, os modelos de estudo foram montados em um articulador semiajustável para enceramento diagnóstico. Então, um guia cirúrgico foi confeccionado e blocos foram usados para aumento horizontal nas regiões anterior e posterior. Um dos blocos foi triturado e colocado na cavidade formada após o levantamento do assoalho do seio maxilar no lado esquerdo. Dez meses depois, uma nova TCFC foi realizada e os implantes instalados. Neste momento, biopsias foram coletadas na interface osso enxertado/nativo. Os resultados histológicos demonstraram viabilidade das células ósseas. Nenhuma complicação foi relatada até os dois anos de controle. A sequência de tratamento proposta forneceu bons resultados estéticos.

This case report describes the use of allogeneic bone grafts for horizontal/vertical augmentation in the maxillary region. A 54 years-old patient presented partial edentulism and moderate to severe atrophy from regions 12 to 26. After CBCT analysis, study models were mounted in a semi-adjustable articulator for diagnostic wax-up. Then, a surgical guide was fabricated and block grafts were used for horizontal augmentation in the anterior and posterior areas. Also, sinus lifting was performed and morselized allogeneic bone packed inside the formed cavity. Ten months later, a new CBCT was performed and dental implants were installed. At this time, bone biopsies were collected at the graft/native bone interface. The histological results demonstrated the presence of viable bone cells. No complications were seen at the two-year follow-up. The proposed treatment sequence provided good esthetic results.

Avaliação do infiltrado inflamatório na gengivite crônica de indivíduos fumantes e não fumantes / Assessment of inflammatory infiltrate in chronic gingivitis of smoker and non-smoker individuals

O tabagismo tem sido considerado pela literatura um dos principais fatores de risco associado à doença periodontal. Substâncias como a nicotina podem afetar a vascularização, o sistema imunológico humoral e celular. Alterações no número de células inflamatórias podem ser observadas também em indivíduos com gengivite crônica. Neste estudo, foram avaliadas 27 amostras de tecidos gengivais que foram agrupadas em 10 amostras de indivíduos com gengivite e não fumantes (GNF), 10 amostras de indivíduos com gengivite e fumantes (GF) e 7 amostras controle (C) formada por indivíduos sem gengivite e não-fumantes. As biópsias foram coradas em hematoxilina-eosina e as células do infiltrado inflamatório foram contadas e expressas suas densidades em células/mm². O infiltrado inflamatório mononuclear foi maior no grupo GNF (137,60 ± 53,18) e GF (91,70 ± 42,59) quando comparado com o grupo C (12,43 ± 4,24), (p=0,0001 e p=0,002 respectivamente). Quando os grupos com gengivite foram comparados, observou-se um menor número de células inflamatórias no grupo GF (p=0,04). Conclui-se que o infiltrado inflamatório aumenta no tecido gengival de indivíduos com gengivite crônica, porém, em indivíduos fumantes, observa-se diminuição dessas células.

The smoking habit has been considered by the literature as one of the major risk factors associated to the periodontal diseases. Substances such as nicotine can affect the vascularization, the humoral and cellular immune system. Changes in the number of inflammatory cells can also be observed in patients with chronic gingivitis. In this study we have evaluated 27 samples of gingival tissues that were divided in three groups: the first one contained 10 samples from nonsmokers patients with gingivitis (GNF), the second contained 10 samples from smokers patients with gingivitis (GF) and the last group contained 07 control samples (C) of nonsmoker patients without gingivitis. The biopsies were stained with hematoxylin-eosin and the inflammatory cells were counted and showed the density in cells/mm². The mononuclear cell infiltration was higher in the GNF (137.60 ± 53.18) and GF (91.70 ± 42.59) when compared with group C (12.43 ± 4.24) (p=0.0001 e p=0.002 respectively). When groups with gingivitis were compared to each other, there was a smaller number of inflammatory cells in the group GF (p=0.04). We conclude that there is an increase of the inflammatory infiltrate in the gingival tissue of patients with chronic gingivitis, however, in smokers patients, there in a decrease of those cells.

Langerhans cells in periodontal disease of HIV- and HIV+ patients undergoing highly active antiretroviral therapy

The aim of this study was to assess and compare quantitatively the presence of S100+ Langerhans cells (LC) by immunochemistry techniques in HIV+ and HIV- gingivitis and periodontitis subjects. Additionally, it aimed to evaluate the correlation among densities of these cells with CD4+ and CD8+ T cells, and viral load levels in HIV+ subjects, all using Highly Active Antiretroviral Therapy (HAART). The samples were allocated into four groups: 1) 15 subjects with moderate chronic periodontitis (MCP), HIV+; 2) 15 subjects with MCP, HIV-; 3) 10 subjects with gingivitis (G), HIV+; and 4) 10 subjects with G, HIV-. The S100+ cells were assessed in the pocket epithelium, gingival epithelium, and lamina propria. A statistically significant increase of total S100+ cells in HIV+ periodontitis subjects was observed in relation to HIV- periodontitis subjects. No increase of S100+ cells with increased inflammation was observed. No statistically significant correlation among S100+ cells and blood levels of CD4, CD8, and viral load was observed. In conclusion, the use of HAART can aid in achieving viral loads, and it is suggested that it may prevent the destruction of the LC.

Lesão liquenóide oral relacionada ao amálgama / Amalgam-related oral lichenoid lesion

A lesão liquenóide oral relacionada ao amálgama, condição rara na prática odontológica, constitui importante diagnóstico diferencial no grupo das leucoplasias orais. Relatam-se dois casos que apresentaram rápida resolução clínica após a substituição das restaurações de amálgama.

Amalgam-related oral lichenoid lesion, a rare disorder in dental practice, is an important differential diagnosis among oral leukoplastic lesions. We report two cases with rapid clinical resolution following the replacement of amalgam fillings.