Oral manifestations of systemic fungal infections: 25-year experience in an endemic region

Some mycoses are endemic. They develop through hematogenous spread, causing a generalized infection, usually with secondary mucosal involvement.The aim of this observational and retrospective study was to report the prevalence and characteristics of oral lesions in patients diagnosed with systemic fungal infections (SFI) over a 25-year period in southern Brazil. Demographic (age, sex, ethnicity, occupation) and clinical (anatomical location, symptoms,histopathological diagnosis and management) data from the medical records of patients with SFI were collected from 1995 to 2019. 34 cases of SFI were found, of which 31 (91.18%) were diagnosed as paracoccidioidomycosis (PCM) and 3 (8.82%) as histoplasmosis. Men were much more affected (n = 31; 91.18%), with an average age of 46.9 years. Most patients (n = 18; 58.06%) were Caucasian; 48% (n = 15) were farm/rural workers and the most affected region was the jugal mucosa (n = 13; 25.49%) followed by the alveolar ridge (n = 12; 23.52%). All patients with histoplasmosis were immunocompetent men (mean age: 52.67 years), and the palate was the most affected. All patients underwent incisional biopsy and were referred to an infectologist. The dentist has an essential role in the recognition of SFI, whose oral manifestations may be the first sign. SFI should be included in differential diagnosis in patients from endemic areas. In addition, the inevitable human mobility and globalization make knowledge of these mycosesnecessary worldwide, especially since advanced cases in immunocompromised patients can be fatal.

Differential diagnosis for an unusual calcification in the maxillary sinus: case report / Diagnóstico diferencial para calcificação incomum em seio maxilar: relato de caso

ABSTRACT The aim of this study was to report a rare case of an asymptomatic calcification of unusual size and shape, inside the maxillary sinus identified on a cone beam computed tomography exam and to discuss the importance of knowledge of the anatomy of maxillary sinus and its changes carefully evaluating the entire volume of the images, regardless of the region of interest. An 83-year-old female patient underwent a cone beam computed tomography exam for other diagnostic purposes in the maxillofacial region. When analyzing the entire volume, an image of unusual limits, hyperdense and calcified was found in the right maxillary sinus, close to the anterior and medial wall, with a rounded and homogeneous shape, occupying approximately one third of the maxillary sinus. There was no lytic or erosive lesions on the maxillary sinus wall. The main diagnostic hypotheses raised were giant anthrolith, mucous retention phenomenon and osteoma. Due to the anatomical complexity of the maxillary sinus, diagnosis in this region becomes a challenge. Considering the limitations of 2D exams, the cone beam computed tomography exam can be used to evaluate these structures. Knowledge of differential hypotheses is extremely important for the case to be conducted correctly, but it does not replace biopsy and histopathological examination.

RESUMO O objetivo desse estudo foi relatar um caso raro de uma calcificação assintomática de tamanho e formato incomum, no interior do seio maxilar, diagnosticado em um exame de tomografia computadorizada de feixe cônico, além de discutir a importância do conhecimento da anatomia do seio maxilar e suas alterações, avaliando cuidadosamente todo o volume das imagens, independentemente da região de interesse. Paciente do sexo feminino, 83 anos de idade, realizou uma tomografia computadorizada de feixe cônico para outros fins de diagnóstico na região bucomaxilofacial. Ao analisar todo volume da tomografia encontrou-se uma imagem de limites incomuns, hiperdensa e calcificada, no seio maxilar direito, próximo a parede anterior e medial, com formato arredondado e homogêneo, ocupando aproximadamente um terço do seio maxilar, com as suas paredes intactas e sem nenhuma lesão lítica ou erosiva. As principais hipóteses diagnosticas levantadas foram antrólito gigante, fenômeno de retenção mucoso e osteoma. Devido a complexidade anatômica do seio maxilar, o diagnóstico nessa região se torna um desafio. Considerando as limitações dos exames 2D, a tomografia computadorizada de feixe cônico pode ser empregada para a avaliação dessas estruturas. O conhecimento do raciocínio diagnóstico e das hipóteses diferenciais são de extrema importância para o que o caso seja conduzido corretamente, porém não substituem a biópsia e o exame histopatológico.

Evaluation of a Protocol For Topical Application of Capsaicine Gel 0.025 % in the Management of Burning Mouth Syndrome Correlating its Impact on Quality of Life

ABSTRACT: The aim of this study is to report the results obtained with a protocol of topical application of capsaicin gel 0.025 % in the management of burning mouth syndrome (BMS) to evaluate the influence of the disease and treatment on their quality of life (QOL) using the OHIP-14 questionnaire (Oral Health Impact Profile). After clinical examination and diagnosis of BMS, 10 patients reported the intensity of the burning by means of a subjective score ranging from 0 to 10 and also answered the OHIP-14. Then, a topical application protocol of capsaicin gel 0.025 % was initiated, with weaning from medication and complete withdrawal within 180 days. At each reassessment consultation (30, 60, 90 and 180 days), the patients answered the OHIP-14 and subjective burning scores were collected again. Overall, the capsaicin gel showed gradual reduction or elimination of symptoms of BMS, as well as an improvement in the QOL of patients throughout treatment. At 180 days, after medication withdrawal, 6 patients (60 %) reported total absence of burning and in four patients (40 %) the score remained or decreased. In one patient (10 %) the score increased, although it remained below the initial score. The results showed an improvement in the QOL of all patients who completed the protocol and the impact of BMS on the QOL decreased in relation to the initial score in all patients. The topical use of 0.025 % capsaicin gel was effective in reducing or remitting symptoms of BMS. The OHIP-14 questionnaire showed the negative impact of BMS on patients' QOL and the role of treatment in its improvement.

RESUMEN: El objetivo de este estudio fue reportar los resultados obtenidos con un protocolo de aplicación tópica de gel de capsaicina al 0,025 % en el manejo del síndrome de boca ardiente (SBA), para evaluar la influencia de la enfermedad y el tratamiento en su calidad de vida (CV) mediante el cuestionario OHIP-14. Tras el examen clínico y diagnóstico de SBA, 10 pacientes refirieron la intensidad del ardor mediante una puntuación subjetiva de 0 a 10 y también respondieron la OHIP-14. Luego, se inició un protocolo de aplicación tópica de gel de capsaicina al 0,025%, con destete de la medicación y retiro completo en 180 días. En cada consulta de reevaluación (30, 60, 90 y 180 días), los pacientes respondieron el OHIP-14 y se recogieron nuevamente las puntuaciones subjetivas de quemado. En general, el gel de capsaicina mostró una reducción o eliminación gradual de los síntomas del SBA, así como una mejora en la calidad de vida de los pacientes durante todo el tratamiento. A los 180 días, después de la retirada de la medicación, 6 pacientes (60 %) informaron ausencia total de ardor y en cuatro pacientes (40%) la puntuación se mantuvo o disminuyó. En un paciente (10 %) la puntuación aumentó, aunque se mantuvo por debajo de la puntuación inicial. Los resultados mostraron una mejora en la CV de todos los pacientes que completaron el protocolo y el impacto de SBA en la CV disminuyó en relación con la puntuación inicial en todos los pacientes. El uso tópico de gel de capsaicina al 0,025 % fue efectivo para reducir o remitir los síntomas del SBA. El cuestionario OHIP-14 mostró el impacto negativo de SBA en la CV de los pacientes y el papel del tratamiento en su mejora.

What has Changed in the Daily Practice of the Dental Imaging Center During the COVID-19 Pandemic?

ABSTRACT: A new type of RNA coronavirus (SARS-CoV-2) related to acute respiratory syndrome (SARS) and responsible for COVID-19 disease has spread around the world, resulting in an unprecedented pandemic. COVID-19 has become an international public health emergency and countless people and sectors have been affected. In this context, individual and collective protection measures were taken, mainly in health care. Dentistry, considered a high risk area, had to undergo changes in relation to biosecurity, including in radiological clinical practice. Thus, this letter aims to comment on these changes during visits to dental imaging centers.

RESUMEN: Un nuevo tipo de coronavirus de ARN (SARS-CoV-2) relacionado con el síndrome respiratorio agudo (SARS) responsable de la enfermedad COVID-19 se ha extendido por todo el mundo y ha provocado una pandemia sin precedentes. COVID-19 se ha convertido en una emergencia de salud pública internacional y un sinnúmero de personas y sectores se han visto afectados. En este contexto, se tomaron medidas de protección individual y colectiva, principalmente en el ámbito de la salud. La atención dental, considerada de alto riesgo, tuvo que sufrir cambios en relación con la bioseguridad, incluida la práctica clínica radiológica. Así, esta carta tiene como objetivo comentar estos cambios durante los atendimientos a los centros de imagenología dental.

Biosecurity Perspectives in Oral and Maxillofacial Radiology in Times of Coronavirus disease (COVID-19): a Literature Review

ABSTRACT: The aim of this work was to report biosecurity measures in the Oral and Maxillofacial Radiology (OMR) clinic in the current context of COVID-19, based on a literature review. An electronic search for scientific papers was perform ed using PubMed, Embase, Web of Science, and Scopus database. Although the literature related to care in the OMR clinic regarding COVID-19 is still scarce, this unprecedented scenario created by the pandemic generated an urgent need for measures to prevent the transmission of the virus. Dentists are at maximum risk of contagion and, although the practice of OMR generally does not produce aerosols, radiologists and technicians are continually in contact with body fluids, such as saliva. In additio n, imaging exams are often indispensable for emergency or elective dental diagnosis and treatment. Training in infection control practices during major outbreaks of infectious diseases should be quickly reinforced and dental settings have unique characteristics that warrant specific infection control considerations. Some recommendations have been proposed and were discussed, which cover patient flow, equipment handling and environment, radiographic technique and processing, personal protective equipment and preparation and issuance of radiological reports and access to exam results. Due to the COVID-19 pandemic, biosecurity measures in the routine of the OMR clinic are indispensable to enable emergency dental care and the perspectives of returning to elective treatment. Biosecurity measures and staff training at the OMR clinic should be instituted immediately, since imaging exams are an important and often indispensable part of dental diagnosis and treatment.

RESUMEN: El objetivo de este trabajo fue reportar las medidas de bioseguridad en la clínica de Radiología Oral y Maxilofacial (OMR) en el contexto actual del COVID-19, a partir de una revisión de la literatura. Se realizó una búsqueda electrónica de artículos científicos utilizando PubMed, Embase, Web of Science y la base de datos Scopus. Si bien la literatura relacionada con la atención en la clínica OMR respecto al COVID- 19 aún es escasa, este escenario inédito creado por la pandemia generó una urgente necesidad de medidas para prevenir la transmisión del virus. Los dentistas tienen el máximo riesgo de contagio y, aunque la práctica en la OMR generalmente no produce aerosoles, los radiólogos y técnicos están continuamente en contacto con fluidos corporales, como la saliva. Además, los exámenes por imágenes a menudo son indispensables para el diagnóstico y el tratamiento dental de emergencia o electivo. La capacitación en prácticas de control de infecciones durante brotes importantes de enfermedades infecciosas debe reforzarse rápidamente y los entornos dentales tienen características únicas que justifican consideraciones específicas de control de infecciones. Se han propuesto y discutido algunas recomendaciones que cubren el flujo de pacientes, el manejo y el entorno del equipo, la técnica y el procesamiento radiográfico, el equipo de protección personal y la preparación y emisión de informes radiológicos y el acceso a los resultados de los exámenes. Debido a la pandemia de COVID-19, las medidas de bioseguridad en la rutina de la clínica OMR son indispensables para posibilitar la atención dental de emergencia y las perspectivas de volver al tratamiento electivo. Las medidas de bioseguridad y la capacitación del personal en la clínica OMR deben instituirse de inmediato, ya que los exámenes por imágenes son una parte importante y, a menudo, indispensable del diagnóstico y tratamiento dental.

Accuracy of cone-beam CT in detecting vertical root fractures in teeth with post-endodontic restorations: an in vitro study

The aim of this study was to evaluate the accuracy of cone-beam CT (CBCT) for the detection of artificially created vertical root fractures (VRF) in extracted teeth restored with metallic (MP) and fiberglass (FGP) posts. After root canal obturation, 60 extracted human premolars were scanned by using the highest-resolution settings of a CBCT unit. Theprepared roots were randomly divided into three groups: group C (control group): non-restored and non-endodontically treated teeth (n = 20); group MP (n = 20); group FGP (n = 20). In all groups, 10 teeth were artificially fractured. Two external and independent observers blindly recorded the presence or absence of VRF. Sensitivity, specificity, accuracy, intra-and interobserver agreement were calculated. Kappa value for inter-and intraobserver agreement was 0.82 and 0.84 respectively, demonstrating goodagreement. The highest values for sensitivity (0.80 -0.90), specificity (1.00) and accuracy (0.90 -0.95) were found in the control group. The teeth with FGP restoration presented the lowest sensitivity (0.30 -0.50) and accuracy (0.60 -0.65) values. Both examiners had a good performance in the diagnosis of fractures in teeth with MP, with accuracy ranging between 0.85 -0.90. The presence of MP did not influence accuracy; however, the presence of FGP reduced the diagnostic capacity of CBCT.

Influence of mandibular positioning on the accuracy and reliability of linear measurements on cone beam CT using different voxels and two software programs / Influência do posicionamento mandibular na acurácia e confiabilidade de medidas lineares em tomografia computadorizada de feixe cônico utilizando diferentes voxels e dois softwares

Objetivo: este estudo avaliou a acurácia e confiabilidadedas medidas lineares em exames detomografia computadorizada de feixe cônico(TCFC), em dois softwares, utilizando diferentesvoxels e variando o posicionamento da mandíbula.Material e Métodos: 10 imagens de TCFC demandíbulas humanas com 25 pontos foram obtidas,usando diferentes protocolos de aquisição(0.250, 0.300, 0.400-mm voxels) e orientações damandíbula (centralizada, rotacionada 10° lateralmentepara direita e esquerda, inclinada 10° para cima e para baixo); 14 medidas foram realizadasnas reconstruções multiplanares nos softwares XoranCate OsiriX. Os achados foram comparadoscom as medidas físicas através de um paquímetrodigital. O teste ANOVA e o coeficiente de correlaçãoforam utilizados com p < 0,05. Resultados:não houve diferença estatisticamente significantequando as medidas foram comparadas em aquisiçõescom diferentes tamanhos de voxels emambos os softwares. A posição da mandíbula nãoinfluenciou nas medidas. Nenhuma diferença foiencontrada quando os valores foram comparadosentre os softwares e o paquímetro digital. Conclusão:as medidas lineares em ambos os softwaresforam confiáveis e acurados comparados a mensuraçãofísica em todos os protocolos. A acuráciae a confiabilidade das mensurações não influenciaramde acordo com as variações de posicionamentoda mandíbula.(AU)

Objective: this study evaluated the accuracy and reliability of linear measurements on cone beam CT (CBCT) scans in two software programs, using different voxels and varying mandible positioning. Material and methods: CBCT images of 10 human mandibles with 25 markers were obtained using different acquisition protocols (0.250, 0.300, 0.400-mm voxels) and mandible orientations (centered, rotated 10° laterally to right and left, tilted 10 up and down); fourteen measurements were carried out on the multiplanar reconstructions in XoranCat and OsiriX Lite software programs. The findings were compared to physical measurements using a digital caliper. ANOVA and correlation coefficient tests were used, at α = 0.05. Results: there was no statistically significant difference when the measurements were compared in acquisitions with different voxel sizes analysed in both software programs. Mandibular positioning changes did not influence the measurements. No differences were found when the values were compared between the software programs and the digital caliper. Conclusion: linear measurements in both programs were reliable and accurate compared with physical measurements when using all acquisition protocols. The accuracy and reliability of the measurements were not influenced by variations in the mandible positioning.(AU)

Inflammatory and developmental odontogenic cysts: 23-year observational and retrospective study / Cistos odontogênicos inflamatórios e de desenvolvimento: estudo observacional e retrospectivo de 23 anos

Objective: This observational and retrospective study evaluated the prevalence and characteristics of odontogenic cysts, outlining the epidemiological profile of these lesions. Material and methods: The following data were collected from the medical records of patients with a diagnosis confirmed by microscopy: age, sex, ethnicity, anatomical location, histopathological diagnosis and treatment, between 1995 and 2018. Results: Of the 70 cysts, 75.7% were inflammatory and 24.2% development. The inflammatory periapical cyst was the most prevalent (62.8%) followed by the dentigerous cyst (71.0%). The lateral radicular cysts and odontogenic keratocysts obtained the same percentage (5.7%), followed by the residual cyst (4.3%), paradental (2.8%) and the orthokeratinized variable (1.5%). Women were slightly more affected (1.12: 1) with greater involvement of leucodermas (80%). Age and anatomical location differed according to each lesion, although the anterior maxilla region was more affected. Enucleation was the most used treatment (75.7%), except for odontogenic keratocysts, in which marsupialization was performed in 75% of the cases. Conclusion: Epidemiological data provide an important insight into the prevalence, extent and severity of these lesions, allowing early diagnosis and prevention, in order to guarantee the reduction of cases and improve the quality of life of the population.

Objetivo: Avaliar a prevalência e características dos cistos odontogênicos de forma observacional e retrospectiva, delineando o perfil epidemiológico destas lesões. Material e Métodos: Foram coletados os seguintes dados dos prontuários de pacientes com diagnóstico confirmado microscopicamente: idade, sexo, etnia, localização anatômica, diagnóstico histopatológico e tratamento, entre os anos de 1995 a 2018. Resultados: Dos 70 cistos, 75,7% eram inflamatórios e 24,2% de desenvolvimento. O cisto periapical inflamatório foi o mais prevalente (62,8%) seguido pelo cisto dentígero (71,0%). O cisto radicular lateral e queratocisto odontogênico obtiveram o mesmo percentual (5,7%), seguidos do cisto residual (4,3%), paradentário (2,8%) e a variável ortoqueratinizada (1,5%). As mulheres foram ligeiramente mais afetadas (1,12:1) com maior acometimento de leucodermas (80%). Idade e localização anatômica diferiram de acordo com cada lesão, embora a região anterior de maxila tenha sido mais afetada. A enucleação foi o tratamento mais utilizado (75,7%), exceto para o queratocisto odontogênico, no qual a marsupialização foi realizada em 75% dos casos. Conclusão: Os dados epidemiológicos fornecem uma visão importante para o entendimento da prevalência, extensão e gravidade dessas lesões, viabilizando o diagnóstico precoce e medidas preventivas, a fim de garantir a redução dos casos e melhorar a qualidade de vida da população.

Limitation of diagnostic value of cone-beam CT in detecting apical root isthmuses

Abstract Isthmuses are reported as common anatomic complexities in teeth often associated with failures in endodontic treatment. They should be considered before starting treatment and a preoperative computed tomography scan (CT) may demonstrate these complexities. Objective To assess the diagnostic value of the highest resolution settings of a cone-beam CT (CBCT) system in identifying and measuring apical isthmuses, using micro-CT as reference. Methodology After micro-CT scanning, 40 humans' lower first molars with isthmuses in the apical-3 mm of mesial roots were scanned by the highest resolution settings of the New Generation i-Cat ® CBCT equipment. Two blinded observers recorded the detection of isthmuses in CBCT scans. The lengths of isthmuses were compared between micro-CT and CBCT to assess the diagnostic value of CBCT. Quantitative data for sensitivity were represented as percentages (95% confidence interval). The Bland-Altman method was used to assess differences between gold standard lengths (micro-CT) and CBCT lengths. Results BCT demonstrated 30 positive findings, representing sensitivity for isthmus identification of 75% (95% CI=0.4114-1.1364). Differences between the lengths in micro-CT (1.99±0.40 mm) and CBCT (1.53±0.41 mm) were significant (p<0.0001). Conclusion The CBCT device used presented limited diagnostic value in the identification and measurement of apical isthmuses in the mesial roots of lower molars. In some cases, the actual anatomy of the apical root canal may not be completely delineated in this type of CBCT system, even using the highest resolution settings.

Manifestações bucais e considerações gerais da síndrome de Behçet: relato de caso / Oral manifestations and general considerations of Behçet's Syndrome: case report

Objetivo: relatar um caso de síndrome de Behçet, enfatizando o controle das manifestações bucais. Relato de caso: paciente de 21 anos de idade, já diagnosticado com síndrome de Behçet há 7 anos, sem histórico familiar, relatou o aparecimento de úlceras recorrentes, quando iniciou tratamento ortodôntico. Procurou a clínica odontológica da Universidade Estadual de Maringá queixando-se de "aftas e carne crescida" na boca. Foi realizada biópsia excisional do nódulo, e o exame histopatológico revelou tecido hiperplásico com infiltrado inflamatório crônico decorrente. Após 45 dias, observaram-se presença de novas aftas em mucosa labial, língua e gengiva assim como total cicatrização na região da biópsia. Atualmente, o paciente permanece em controle clínico médico e odontológico, estando as lesões aftosas presentes em diferentes regiões. Considerações finais: apesar de rara, essa doença é de grande relevância para o cirurgião-dentista, que deve saber diagnosticá-la e controlar suas manifestações bucais. Além disso, o acompanhamento é necessário para melhorar a qualidade de vida do paciente. (AU)

Objective: report a case of Behçet's Syndrome, emphasizing the control of oral manifestations. Case report: a 21-year-old patient, diagnosed with Behçet's Syndrome for 7 years, with no family history, reporting recurrent ulcers when orthodontic treatment was started. He sought a dental clinic at the State University of Maringá complaining of "aphthae and grown flesh" in the mouth. Excisional nodule biopsy and histopathological examination of hyperplastic tissue with chronic inflammatory infiltrate were performed. After 45 days, the presence of new aphthae were observed in the labial mucosa, tongue and gingiva, as well as total scarring in the region of the biopsy. Currently, the patient remains in clinical and dental control, remaining as aphthous interventions present in different regions. Final considerations: although rare, this disorder is of great relevance for the dental practioner, who must know how to diagnose and control its oral manifestations. In addition, follow-up is necessary to improve the patient's quality of life. (AU)

Nova classificação da OMS para tumores odontogênicos: o que mudou? / Updated WHO classification for odontogenic tumors: what has changed?

Objetivo: apresentar e discutir as mais relevantes modificaçõesna quarta classificação de tumores de cabeçae pescoço da Organização Mundial de Saúde (OMS),no ano de 2017, especialmente para os tumores odontogênicos.Revisão de literatura: o trabalho baseia-seem uma revisão da literatura relacionada ao tema, emespecial no artigo publicado pelos professores John M.Wright e Marilena Vered no Head & Neck PathologyJournal, no ano de 2017, o qual apresenta as principaisatualizações desde as reuniões de 1992 e 2005. O quefoi excluído da terceira edição, o que foi retomado dasegunda edição, as novas descobertas e o porquê detais mudanças serão alguns pontos abordados. Consideraçõesfinais: observa-se que as atualizações foramorientadas pelos princípios de simplicidade, relevânciaclínica, validade científica e utilidade, no intuito defornecer uma classificação contemporânea e menoscomplexa, servindo como base para o clínico e o patologistaem termos de diagnóstico e condução dos casos. (AU)

Objective: this study aimed to present and discuss the most relevant updates in the 4th classification of head and neck tumors by the World Health Organization (WHO) in 2017, especially for odontogenic tumors. Literature review: the study is based on a literature review related to the topic, particularly on the article published by Professors John M. Wright and Marilena Vered in the Head & Neck Pathology Journal in 2017, which presents the main updates since the meetings of 1992 and 2005. What was excluded from the third edition and resumed from the second one, the new findings and the reason for such changes will be some of the points addressed. Final considerations: it is observed that the updates were guided by the principles of simplicity, clinical significance, and scientific validity and utility, in order to provide a contemporary and simpler classification that works as a basis for practitioners and pathologists in terms of diagnosis and management of cases. (AU)

Manifestações imaginológicas distintas na displasia cemento-óssea florida

Objetivo: o objetivo do presente trabalho é relatar dois casos clínicos de pacientes com displasia cemento-óssea florida (DCOF) com características distintas no exame de tomografia computadorizada de feixe cônico (TCFC). Relato de caso: no primeiro caso, paciente do gênero feminino, melanoderma, 49 anos de idade com lesões hipodensas assintomáticas distribuídas por toda a mandíbula, sugestivas de DCOF em estágio imaturo. No segundo caso, uma paciente do gênero feminino, melanoderma de 48 anos de idade, as lesões apresentavam-se hiperdensas com halo hipodenso, em mandíbula localizada bilateralmente, assintomáticas, caracterizando o estágio maduro da DCOF. Em ambos os casos, o diagnóstico de DCOF foi estabelecido por meio das imagens de TCFC associadas às características clínicas das pacientes. Nenhum tratamento foi instituído, apenas o controle periódico. Considerações finais: os casos clínicos apresentados ressaltam a importância da TCFC no diagnóstico das lesões fibro-ósseas, que, como ilustrado, podem apresentar características imaginológicas bastante distintas. Por possuir um amplo espectro de apresentações e ser encontrada em exames de imagens realizados para outros fins, a DCOF pode levar o cirurgião dentista à tomada de decisões precipitadas e, muitas vezes, condutas inadequadas, visto que procedimentos cirúrgicos são contraindicados nesses casos.

Análise do perfil facial esquelético e de tecidos moles pré e pós-cirurgia ortognática em pacientes Classe II e III, e sua relação com a proporção áurea / Analysis of the skeletal and soft-tissue profiles pre and post orthognathic surgery in Class II and III patients and its relation with the golden proportion

Introdução: A proporção áurea, representada pela razão matemática 1:1.618, tem sido investigada na especialidade Ortodontia e no procedimento de Cirurgia Ortognática, a fim de ser estabelecida como um guia de sucesso clínico relacionado à estética facial. Objetivo: Verificar a estética dos perfis faciais de pacientes Classes II e III de Angle, antes e após tratamento ortodôntico-cirúrgico, além de correlacionar 13 razões dentoesqueléticas e cinco razões de tecidos moles à proporção áurea. Material e método: Um total de 94 radiografias cefalométricas laterais foram analisadas, em que 13 razões dentoesqueléticas e cinco razões em tecidos moles foram medidas e comparadas ao número áureo. Adicionalmente, uma análise subjetiva da estética facial pré e pós-tratamento foi realizada por 270 examinadores. Resultado: As razões dentoesqueléticas 1, 3, 6, 7, 8 e 9 aproximaram-se do número áureo após a cirurgia ortognática, nos pacientes Classe III. Para o perfil mole, apenas a razão 4 se aproximou ao número áureo, em ambos os pacientes Classe II e III. Em relação à avaliação subjetiva da estética, 91,49% dos perfis faciais foram considerados mais harmônicos após o tratamento. Conclusão: Frente à metodologia usada, pode-se concluir que a proporção áurea exerce pouca influência na avaliação da estética facial, não servindo como um guia para o planejamento e o tratamento ortodôntico-ortognático.

Introduction: The golden proportion, represented by the mathematical ratio 1:1.618, has been investigated in Orthodontics and orthognathic surgery in order to be established as a guide to clinical success related to facial aesthetics. Objective: To verify the facial aesthetics of patients with Angle Class II and III deformities pre and post orthodontic-surgical treatment, and to analyze if 13 dental-skeletal patters (ratios) and 5 soft tissue ratios moved closer to or further away from the golden proportion after the orthognathic surgery. Material and method: A total of 94 lateral cephalometric radiographs, in which 13 dental-skeletal ratios and 5 soft tissue ratios were measured and compared to the golden number. In addition, 270 examiners performed a subjective analysis of facial esthetics before and after treatment. Result: Dental-skeletal ratios 1, 3, 6, 7, 8 and 9 moved closer to the golden number after orthognathic surgery in Class III patients. For the soft tissue profile, only ratio 4 moved closer to the golden number in both Class II and III patients. Regarding the subjective evaluation of facial aesthetics, 91.49% of the facial profiles were considered more harmonic after treatment. Conclusion: Considering the methodology, it may be concluded that the golden proportion had little effect on the facial aesthetics evaluation and should not work as a guide for orthodontic-orthognathic planning and treatment.

Association between oral lichen planus and hepatitis C: retrospective study and case report / Associação entre líquen plano oral e hepatite C: estudo retrospectivo e relato de caso

Oral Lichen Planus (OLP), a chronic inflammatory disease of unknown etiology, which affects the skin and/or mucosal tissues, is an autoimmune disease (pathology) of special interest to dentists due to its oral manifestations and its possible association with Hepatitis C virus (HCV). Although a possible association has been extensively discussed in the literature, the results have been controversial. So that the relationship between Oral Lichen Planus (OLP) and infection by HCV (OLP-HCV) may be investigated, current study conducted an epidemiological survey of all OLP cases diagnosed in two reference projects, with regard to diagnosis, treatment and epidemiology of oral lesions in Maringá, Paraná, Brazil. In addition, the clinical case of a patient with HCV and the clinical manifestation of severe OLP will be provided. A total of 3,488 clinical records of biopsies performed between 1994 and 2014 and 85 cases of OLP were selected for the present study. The reticular type of OLP showed significant prevalence but only 2.3% of OLP cases revealed any association with HCV.

Líquen Plano (LP) é uma doença inflamatória crônica de etiologia desconhecida, que acomete pele e/ou mucosas. Esta doença autoimune é de especial interesse para o cirurgião-dentista pelo fato de apresentar manifestações bucais e pode estar associado ao vírus da hepatite C (VHC). Esta possível associação tem sido muito discutida na literatura, apresentando resultados controversos. Com o intuito de investigar a relação entre o Líquen Plano Oral (LPO) e a infecção pelo VHC (LPO-VHC), o presente trabalho objetivou conduzir um levantamento de todos os casos de LPO diagnosticados em dois projetos de referência quanto a diagnóstico, tratamento e epidemiologia de lesões bucais na cidade de Maringá, Paraná, Brasil. Adicionalmente, um caso clínico de um paciente portador do VHC com manifestação clínica severa de líquen plano será apresentado. Foram selecionados para o presente estudo um total de 3.488 prontuários de biópsias realizadas entre os anos de 1994 e 2014 e 85 casos de LPO. O LPO do tipo reticular apresentou prevalência estatisticamente significante e apenas 2.3% dos casos de LPO apresentaram associação com o VHC.

Potencial de transformación maligna del liquen plano oral: estudio retrospectivo / Potential malignant transformation of oral lichen planus: retrospective study

El liquen plano oral (LPO) es una enfermedad mucocutánea inflamatoria más común en las mujeres. Su etiología aún no es bien definida y esta condición puede estar relacionada, por ejemplo, a la ansiedad, estrés, diabetes, las enfermedades autoinmunes, infecciones y predisposición genética. El LPO se manifiesta en dos formas principales: reticular y erosivo. El objetivo de esta investigación es, a través de un estudio retrospectivo, analizar el posible potencial maligno del LPO. Se analizaron los registros de los pacientes atendidos en dos proyectos de lesiones bucales de dos diferentes instituciones en el período de 1995 a 2014. Se recogieron datos como género, edad, presencia de enfermedad sistémica, presencia de lesiones en la piel, tabaquismo, duración de la lesión, localización, síntomas, tratamiento, proservación y transformación maligna. Los resultados mostraron que, de los 3488 analizados, 85 (2,4%) tuvieron un diagnóstico confirmado de LPO, que afecta fundamentalmente a pacientes de sexo femenino (85%) siendo el LP reticular más común. En relación a la transformación maligna del LPO, 1 paciente (0,85%) tenía carcinoma de células escamosas 4 años después del diagnóstico inicial de LPO. Además, 3 pacientes mostraron atipia celular moderada en el diagnóstico. Los resultados refuerzan el potencial de transformación maligna del LPO. Aunque esta asociación es especulativa, la posibilidad debe ser considerada por los profesionales, que deben presentar estos pacientes a largos periodos de preservación.

Oral lichen planus (OLP) is an inflammatory mucocutaneous disease, more common in females. Its etiology is not yet well defined; this condition may be related, for example, to anxiety, stress, diabetes, autoimmune diseases, infections and genetic predisposition. The OLP manifests itself in two main forms: reticular and erosive. This work aims to perform a retrospective study analyzing the possible malignant potential of OLP. Records of the patients were analyzed in two projects of oral lesions in two different institutions in the period from 1995 to 2014. Data as gender, age, presence of systemic disease, presence of skin lesions, smoking, duration of the injury, location, symptoms, treatment, follow-up time and malignant transformation were collected. The results showed that, of the 3488 analyzed, 85 (2.4%) had a confirmed diagnosis of OLP, which mainly affected female patients (85%) being the most common the reticular LP. Regarding the malignant transformation of OLP, one patient (0.85%) had squamous cell carcinoma 4 years after the initial diagnosis of OLP. In addition, 3 patients showed moderate cellular atypia. The results reinforce the potential of malignant transformation of OLP. Although this association is speculative, this possibility must be considered by the dental practitioners, who must submit these patients to long periods of monitoring.

Acinar autolysis and mucous extravasation in human sublingual glands: a microscopic postmortem study

Although some morphological investigations on aged human sublingual glands (HSG) found eventual phenomena identified as autolysis and mucous extravasation, the exact meaning of these findings has not been elucidated.Objective The aim of this work is to investigate whether acinar autolysis and mucous extravasation are related to the aging process in human sublingual glands. We also speculate if autolytic changes may assist forensic pathologists in determining time of death.Material and Methods 186 cadavers’ glands were allocated to age groups: I (0–30 years); II (31–60), and III (61–90). Time and mode of death were also recorded. Acinar autolysis and mucous extravasation were classified as present or absent. Ultrastructural analysis was performed using transmission electron microscopy (TEM). Data were compared using Mann-Whitney U, Spearman’s correlation coefficient, Kruskal-Wallis, and Dunn tests (p<0.05).Results There was correlation between age and acinar autolysis (r=0.38; p=0.0001). However, there was no correlation between autolysis and time of death. No differences were observed between genders. TEM showed mucous and serous cells presenting nuclear and membrane alterations and mucous cells were more susceptible to autolysis.Conclusion Acinar autolysis occurred in all age groups and increased with age while mucous extravasation was rarely found. Both findings are independent. Autolysis degrees in HSG could not be used to determine time of death.

Phenotype and cell proliferation activity of duct-like structures in human sublingual glands: a histological and immunohistochemical study

There are several age-related microscopic changes in the salivary glands, including the increase in the number of duct-like structures (DLS). However, the true origin and the phenotype of the DLS are not known. Objective To evaluate the phenotype and the cell proliferation index of the DLS of human sublingual glands. Material and Methods Sixty sublingual glands obtained from human cadavers were divided into two groups - 0-30 and 61-90 years old. The phenotype was estimated by immunostaining for cytokeratin 19 (CK 19) and the S-100 protein as well as by the presence of mucin and glycogen. The cell proliferation index was determined by the Ki-67 antibody. The histochemical techniques used periodic acid-Schiff (PAS) and Alcian Blue. In each captured microscopic field, the DLS were counted to establish a percentage for the staining profile. The statistical analysis was accomplished using Student's t-test, the Mann-Whitney test and Pearson's correlation coefficient (p<0.05). Results Comparing both groups, only CK 19 showed a statistically significant difference (p=0.033), with the strongest expression in the elderly group. There was no significant difference between PAS and Alcian Blue (p=0.270). In both groups, the immunostaining for CK 19 was stronger than that for S-100 (p=0.004;p<0.001), but there was no correlation between the two immunomarkers (ρ=-0.163; p=0.315). There was no immunostaining for Ki-67. Conclusions DLS demonstrate a ductal phenotypic profile and do not present cell proliferation activity. DLS may represent a regressive process arising from acini or represent the result of metaplasia. .

Combination of dentoalveolar traumatic injury: a case report (10 - year follow-up) / Associação de injúrias traumáticas dentoalveolares: relato de caso (10 anos de controle

Tooth Injury comprises a group of clinical conditions that might lead to separation or breakage of tooth and its surrounding tissues. A case of multiple concomitant dental trauma is reported. In 2004, a female patient, 11 years old, visited the dental office half hour after dental trauma caused by a fall in the pool. She complained of mild discomfort in tooth 11 (right central maxillary permanent incisor); in the clinical assessment, the tooth showed partial displacement from its socket and grade 2 mobility; in the radiographic analysis, the tooth showed anincrease in periodontal ligament space, a diagnosis of extrusive luxation. The adjacent teeth 21 and 22 (left central and lateral maxillary permanent incisors), presented subgingival bleeding, and were diagnosed with subluxation. After treatment planing, the clinical approach consisted of manual reduction of tooth 11 and non-rigid splint of the affected teeth. The patient received prescription of antibiotic andanti-inflammatory medicine. After 15 days, the splint was removed and teeth 11, 21 and 22 showed pulpal sensibility, maintaining the same results for 4 months. In the 4th month, tooth 11 was diagnosed with pulp necrosis, thus requiring endodontic treatment. After 10 years, teeth were asymptomatic, with a slightcolor change in tooth 11; cone beam scan indicated root resorption in the apical third of the three elements and the presence of dystrophic calcificationin teeth 21 and 22. In conclusion, the injured teeth remained in function with relevant follow-up period, highlighting the search for a response, upon the purpose of the study...

Os traumatismos dentários são um grupo de situações clínicas que podem apresentar a separação ou ruptura do dente e de seus tecidos adjacentes.Um caso de múltiplos traumatismos dentários concomitantes será relatado. Em 2004, paciente do gênero feminino, 11 anos, compareceu ao consultório odontológico meia hora após sofrer um traumatismo dentário causado por queda na piscina. Queixava-sede leve desconforto no dente 11 que clinicamente, apresentava-se parcialmente deslocado de seu alvéolo e com grau 2 de mobilidade. Radiograficamente, comum aumento do espaço do ligamento periodontal obtendo um diagnóstico de luxação extrusiva. Os dentes adjacentes, 21 e 22, com sangramento subgengival foram diagnosticados com subluxação. Após elaboração do plano de tratamento, a conduta clínica consistiu na redução manual do dente 11 e contenção não rígida dos dentes acometidos. A paciente foi apoiada com terapia medicamentosa, com antibiótico e anti-inflamatório. Após 15 dias, a contenção foi removida, e os dentes 11, 21 e 22 apresentavam-se com sensibilidade pulpar, mantendo os mesmos resultados durante 4 meses. No 4º mês diagnosticou-se necrose pulpar do dente 11, requerendo assim, intervenção endodôntica. Após 10 anos, ao exame clínico os dentes apresentam-se assintomáticos, sendo que o dente 11 sugere leve alteração de cor; enquanto que por meio da análise cone beam verifica-se reabsorção radicular no terço apical dos três elementos e presença de calcificação distrófica do 21 e 22. Concluiu-se que, os dentes traumatizados permanecem em função com período de controle relevante, destacando-se procurar uma resposta frente ao objetivo do estudo...

Cisto ósseo simples: relato de casos clínicos / Simple bone cyst: report of cases

Introdução: o Cisto Ósseo Simples (COS) é classificado pela Organização Mundial de Saúde (OMS) como uma lesão não neoplásica relacionada aos ossos, sendo definida como um cisto intraósseo. A causa e a patogênese são incertas e controversas. Grande parte das lesões são cavidades vazias, contendo não mais que um pequeno fluido seroso ou serosanguinolento, estando o revestimento epitelial ausente. Os locais mais acometidos são ossos longos e gnáticos. Os ossos gnáticos surgem com maior frequência na mandíbula em área de molares e pré-molares, com caráter assintomático, porém podem ser relatadas dor e parestesia em alguns casos. Objetivo: este trabalho visa relatar três casos de COS com manifestações radiográficas e condutas terapêuticas distintas. Considerações finais: o diagnóstico do COS é baseado, primariamente, em características clínicas e radiográficas juntamente com os achados cirúrgicos. Radiograficamente apresenta-se como uma lesão radiolúcida, bem delimitada, podendo ser observadas interdigitações entre as raízes dentárias. A forma de tratamento indicada é a curetagem da lesão, com acompanhamento radiográfico pós-cirúrgico para preservação do caso, ou em casos em que as características clínicas e radiográficas são bastante sugestivas, pode-se optar somente pela proservação.

Contribuição da radiografia panorâmica no diagnóstico da osteoporose / Contribution of the panoramic radiograph on the diagnosis of the osteoporosis

Considerada como a epidemia silenciosa do século pela Organização Mundial de Saúde, a osteoporose afeta milhões de pessoas em todo o mundo. A perda de osso ocorre progressivamente e muitas vezes sem sintomas, até que uma fratura ocorra pela primeira vez. A densitometria é hoje o exame de referência para o diagnóstico da osteoporose. A osteoporose também pode apresentar manifestações na cavidade oral e, baseando-se nesses achados, alguns estudos têm procurado demonstrar que a radiografia panorâmica pode auxiliar no diagnóstico da osteoporose. Este trabalho tem como objetivo discutir a utilização da radiografia panorâmica no diagnóstico precoce da osteoporose por meio de revisão de literatura

Considered the silent epidemic of the century by the World Health Organization, the osteoporosis affects millions of people worldwide. The bone loss occurs gradually and often without symptoms until a fracture occurs. Densitometry is today the reference test for the diagnosis of osteoporosis. Osteoporosis can also present manifestations in the oral cavity and, based on these findings, some studies have attempted to demonstrate that the panoramic radiograph can assist in the diagnosis of osteoporosis. This study aims to discuss the use of panoramic radiography in early diagnosis of osteoporosis by means of literature review