Rare ocular disorder of the optic disc resulting from a defect on the development of the neuroectoderm: morning glory disc anomaly / Trastorno ocular infrecuente del disco óptico resultante de un defecto en el desarrollo del neuroectodermo: anomalía de de morning glory

Introducción: Se describen los signos clínicos de la anomalía de Morning Glory en una paciente femenina. Aunque esta anomalía es de baja prevalencia, la reportamos por la importancia del diagnóstico temprano debido a la asociación con alteraciones vasculares del sistema nervioso central que eventualmente son tratables. Objetivo: describir esta anomalía del disco óptico en una paciente atendida en el Hospital de San José, Bogotá. Métodos: búsqueda en la literatura de las manifestaciones clínicas, incidencia y patologías asociadas. Presentación del caso: mujer que consulta por pobre agudeza visual del ojo derecho cuya fundoscopia reveló una excavación cónica con disco óptico displásico y tejido glial alrededor de la pupila en 360 grados, pigmento retinocoroideo y aumento de los vasos retinianos que emergen del disco en distribución radial.

Introduction: We describe the clinical findings of morning glory optic disc anomaly, in a female patient. Despite the low prevalence of this optic disc malformation and although it has no specific treatment, we report this case, for timely diagnosis is important for associated vascular and central nervous system abnormalities may eventually be treated. Objective: to report this case of morning glory optic disc anomaly in a patient seen at Hospital de San José, Bogotá. Study design: case report. Methods: A search in the literature on the incidence, ophthalmological manifestations, clinical presentation and concomitant pathologies of morning glory optic disc anomaly, was conducted. Case report: female patient that consulted for decreased visual acuity in the right eye. Right eye fundus examination revealed a funnel-shaped excavation, dysplastic optic disc and glial tissue covering the peripapillary region circumferentially (360°), chorioretinal pigmentary changes, and increased number of retinal vessels emerging from the optical disc in a radial pattern.

Seguimento de longo prazo de pacientes com tumor neuroendócrino da papila duodenal submetidos à papilectomia endoscópica: série de casos e revisão da literatura / Long-term follow-up of patients undergoing endoscopic papillectomy for papillary neuroendocrine tumor: a case series and literature review

ABSTRACT BACKGROUND: Duodenal papilla neuroendocrine tumors (DP-NET) are rare. Surgical therapy may be recommended for their treatment. However, they have high rates of morbidity and mortality. Endoscopic papillectomy (EP) is safe and effective for complete resection of tumors at this site. OBJECTIVE: This study aimed to describe a case series of DP-NETs resected by EP and perform a literature review. METHODS: A series of patients with DP-NETs underwent EP as primary treatment between Jan/2008 and Mar/2020 at a tertiary referral center. A comprehensive search was made on the MEDLINE primary electronic database. The search strategy was designed to find all articles related to DP-NETs published in the literature. RESULTS: Six patients underwent EP for presenting DP-NETs, four of whom were women (mean age, 63 years). The mean diameter of DP-NETs was 1.6±0.3 cm. Four of six patients were followed up, one of whom suffered relapse at the resection site after 3 months and was referred to surgery (pT3n1b) and the remaining three patients experienced no endoscopic or histological recurrence during follow-up periods of 10, 7, and 4 years, respectively. Eighteen articles were found in the literature search in MEDLINE. The articles included case reports of endoscopically treated DP-NETs. CONCLUSION: EP is safe and effective for DP-NETs that are ≤20 mm, confined to the submucosal layer, well-differentiated, and without local or remote metastasis. Adequate endoscopic follow-up and definitive surgical treatment in the presence of relapse are necessary.

RESUMO CONTEXTO: Tumores neuroendócrinos da papila duodenal (TNE-PD) são raros. A cirurgia deve ser recomendada para o tratamento. No entanto, apresentam altas taxas de morbimortalidade. A papilectomia endoscópica (PE) é segura e eficaz para a ressecção completa de tumores nesta região. OBJETIVO: Descrever uma série de casos de TNEs-PD ressecados por PE e realizar uma revisão da literatura. MÉTODOS: Pacientes com TNEs-PD submetidos a PE como tratamento primário com intenção curativa entre jan/2008 e mar/2020 em um centro de referência terciário foram estudados. Uma pesquisa abrangente foi feita no MEDLINE. A estratégia de busca foi desenhada para encontrar todos os artigos relacionados a TNEs-PD publicados na literatura, que haviam sido submetidos a PE. RESULTADOS: Seis pacientes foram submetidos a PE por apresentar TNEs-PD, sendo quatro mulheres, com média de idade de 66 anos (22-96). O diâmetro médio dos TNEs-PD foi de 1,8±0,4 cm. Quatro dos seis pacientes foram acompanhados, um dos quais sofreu recidiva no local da ressecção após 3 meses e foi encaminhado para cirurgia (pT3n1b), e os três pacientes restantes não apresentaram recorrência endoscópica ou histológica durante os períodos de acompanhamento de 10, 7 e 4 anos, respectivamente. Dezoito artigos foram encontrados no MEDLINE. Os artigos incluíram relatos de casos de TNEs-PD tratados pela PE. CONCLUSÃO: A PE é segura e eficaz para TNEs-PD ≤20 mm, confinados à camada submucosa, bem diferenciados e sem metástases locais ou remotas. Acompanhamento endoscópico adequado e tratamento cirúrgico definitivo na vigência de recidiva são necessários.

Tratamiento endoscópico de adenomas de la papila menor: reporte de dos casos / Endoscopic treatment of minor papilla adenomas: Report on two cases

Resumen Existen numerosas publicaciones sobre resección endoscópica de lesiones de la papila mayor, pero solo se han presentado series de casos individuales de resección de lesiones de la papila menor. En el presente artículo se describe el éxito técnico y la seguridad de la resección endoscópica de dos lesiones adenomatosas de la papila menor.

Abstract There are various publications on endoscopic resection of major papilla lesions, but only individual case series of resection of minor papilla lesions have been reported. This article describes the technical success and safety of endoscopic resection of two adenomatous lesions of the minor papilla.

Study of morphometric and ruminal parameters in santa inês sheep fed spineless cactus (Opuntia ficus-indica, MILL) / [Estudo dos parâmetros morfométricos e ruminais em ovinos Santa Inês alimentados com cactus sem espinhos (Opuntia ficus-indica, MILL)]

The present study aimed to morphometrically evaluate the ruminal mucosa and ruminal fluid characteristics of Santa Inês sheep fed different levels of spineless cactus as a replacement for Tifton grass hay. A total of 32 intact male Santa Inês sheep, approximately 180 days old and with a mean weight of 32.0±1.6kg, were studied in a completely randomized design with four treatments and eight replicates. The morphometric measurements evaluated in the ruminal epithelium (papilla height and surface area) were significantly affected (P< 0.05) by supplementation of the diet with spineless cactus, and these effects showed increasing linear trends. Evaluations of the ruminal fluid also showed a significant increasing linear effect (P< 0.05) for ammonia and a quadratic effect for microbial protein. The inclusion of spineless cactus in the sheep diet affects the ruminal epithelium morphology, including the papilla height and surface area, and favors the absorption process in the rumen. The diet containing higher levels of spineless cactus led to maximum microbial protein production. These results characterize spineless cactus as a feasible alternative for feeding sheep during periods of drought, when the typical food source is scarce.(AU)

O presente estudo teve como objetivo avaliar morfometricamente a mucosa ruminal e as características do líquido ruminal de ovinos Santa Inês alimentados com diferentes níveis de palma forrageira como substituta do feno de capim-Tifton. Um total de 32 ovinos, machos inteiros, da raça Santa Inês, com aproximadamente 180 dias de idade e peso médio de 32,0±1,6kg, foi estudado em delineamento inteiramente ao acaso, com quatro tratamentos e oito repetições. As medidas morfométricas avaliadas no epitélio ruminal (altura e área superficial da papila) foram significativamente afetadas (P<0,05) pela suplementação da dieta com palma forrageira, e esses efeitos mostraram tendências lineares crescentes. As avaliações do fluido ruminal também mostraram um efeito linear crescente significativo (P<0,05) para a amônia e um efeito quadrático para a proteína microbiana. A inclusão de palma forrageira na dieta de ovinos afeta a morfologia do epitélio ruminal, englobando a altura e a área da papila, e favorece o processo de absorção no rúmen. A dieta contendo níveis mais altos de palma forrageira levou à produção máxima de proteína microbiana. Esses resultados caracterizam a palma forrageira como uma alternativa viável para a alimentação de ovelhas durante períodos de seca, quando a fonte típica de alimento é escassa.(AU)

Reconstrucción de la papila interdental con ácido hialurónico. Artículo de Revisión Corto / Interdental papilla reconstruction with hyaluronic acid. Mini review

Uno de los problemas estéticos odontológicos más frecuentes es la presencia de triángulos negros por la pérdida de la papila interdental. Existen varias opciones de tratamiento quirúrgico y no quirúrgico para corregir esta anomalía, entre las más novedosas y menos invasivas, encontramos la utilización de un gel inyectable de ácido hialurónico para la reconstrucción de la papila interdental. El objetivo del estudio fue realizar una recopilación bibliográfica sobre la efectividad del ácido hialurónico como tratamiento para la reconstrucción de la papila interdental.

One of the most frequent cosmetic dental problems is the presence of black triangles due to the loss of the interdental papilla. There are several surgical and non-surgical treatment options to correct this anomaly, among the most innovative and less invasive we found the use of an injectable gel of hyaluronic acid for the reconstruction of the interdental papilla. The objective of the study was to carry out a bibliographic compilation on the effectiveness of hyaluronic acid as a treatment for the reconstruction of the interdental papilla.

Remodelación de papila gingival interdental con ácido hialurónico. Una solución estética / Remodeling interdental gingival papilla with hyaluronic acid. An aesthetic solution

RESUMEN: El objetivo de este trabajo es evaluar el efecto de remodelación y relleno mediante aplicación de ácido hialurónico en papilas gingivales de sector estético con defectos de triángulo negro en un paciente tratado periodontalmente. Se inyectaron 0.15 ml de gel de ácido hialurónico dividido en 3 sesiones. Clínicamente se observó aumento de volumen y aumento de dimensiones verticales y horizontales en las papilas, mejorando así los parámetros estéticos. Como conclusión la aplicación de ácido hialurónico es efectiva en la remodelación y relleno en pérdidas de papila clase I de Nordland y Tarnow.

ABSTRACT: The objective of this work is to evaluate the effect of remodeling and filling through the application of hyaluronic acid in gingival papilla in the aesthetic sector with black triangle defects, in a periodontally- treated patient. In 3 portioned sessions, 0.15 ml of hyaluronic acid gel was injected. Clinically, an increase in volume was observed, and vertical and horizontal dimensions in the papilla increased too, thus improving aesthetic parameters. In conclusion, the application of hyaluronic acid is effective in the remodeling and filling in losses of class I papilla (Nordland and Tarnow classification).

Una Nueva Alternativa para la Creación de Papilas en Implantes de Carga inmediata: Reporte de Caso / A New Alternative for the Creation of Papillae in Immediate Loading Implants: Case Report

RESUMEN: El objetivo de este artículo es evaluar el éxito clínico de una nueva alternativa para crear papilas en implantes de carga inmediata, que se realizó en una paciente de sexo femenino de 26 años de edad. Se inició el tratamiento con la confección de una guía quirúrgica, previo a la manipulación de los tejidos para crear las papilas peri-implantarias. En la cirugía se realizan 2 incisiones semilunares, unidas por una incisión perpendicular, las que al suturarlas sobre ellas mismas permitió crear las papilas; se instala un implante con buena estabilidad primaria y se toma la impresión para la rehabilitación. A las 24 horas se instala una corona atornillada, mostrando la presencia de las papilas de forma inmediata. Se realiza controles hasta los 20 meses de función, evidenciando buena estabilidad de las papilas mesial y distal sin presentar ningún tipo de complicación.

ABSTRACT: The aim of this paper is to evaluate the clinical success of a new alternative to create papillae in immediate load implants, which was performed in a 26-yearold female patient. The treatment was started with the preparation of a surgical guide, prior to the manipulation of tissues to create the peri-implant papillae. In the surgery, two semilunar incisions are made, joined by a perpendicular incision, which when sutured on them allowed to create the papillae. An implant with good primary stability is installed and the impression is taken for rehabilitation. At 24 h a screwed crown is installed, showing the presence of the papillae immediately. Controls are performed up to 20 months of function, demonstrating good stability of the mesial and distal papillae without presenting any type of complication.

Uso de ácido hialurónico como alternativa para la reconstrucción de la papila interdental / Use of hyaluronic acid as an alternative for reconstruction of interdental papilla

RESUMEN: Introducción: El ácido hialurónico (AH) es un glucosaminoglicano esencial de la matriz extracelular de todos los tejidos, estando en una concentración media del 0.02%. Una persona de 60 kg de peso contiene aproximadamente 12 g de AH; las mayores concentraciones de este ácido se encuentran en los tejidos conectivos como la piel, la cual presenta hasta un 56% de éste. El AH tiene un papel importante en la migración celular, ya que está involucrado en procesos de crecimiento, inflamación y reparación, así como estimulación de diferentes células del tejido conectivo. Objetivo: Presentar un caso clínico de reconstrucción de la papila interdental infiltrando AH. Caso clínico: Paciente femenino de 24 años de edad que al interrogatorio refiere ser sistémicamente sana. Presenta pérdida de la papila interdental de la zona OD 11 y 21 a causa de una gingivitis y mala técnica de cepillado. Se valora de acuerdo con la clasificación de Nordland y Tarnow para saber el grado de predictibilidad del procedimiento y de acuerdo con la clasificación de Cardaropoli, con el fin de poder realizar comparaciones antes y después del tratamiento. La paciente presentaba 5 mm del punto de contacto a la cresta ósea, por lo que se realizó un infiltrado de AH en la papila durante cuatro semanas cada siete días. Conclusión: Existen muy pocas técnicas no quirúrgicas para la regeneración de la papila interdental, dentro de ellas encontramos el uso de AH. Las investigaciones sobre esta técnica no son nuevas, sin embargo, se deben continuar y ampliar los estudios considerando diversos factores: realizarlos en poblaciones mayores con personas de distintas razas, sexo y utilizando diferentes intervalos de infiltración.

ABSTRACT: Introduction: Hialuronic acid (HA) is an essential glucosaminoglycan of the extracellular matrix of all tissues; it is found at an average concentration of 0.02%. A subject weighing 60 kg contains approximately 12 g of HA. The greater concentrations of this acid are found in connective tissue such as the skin, which exhibits up to 56% percent of said acid. HA plays an important role in cell migration, since it is involved in processes of growth, inflammation and reparation as well as stimulation of different connective tissue cells. Objective: To present a clinical case involving interdental papilla reconstruction with HA infiltration. Clinical case: 24 year old female who reported being systemically healthy. The patient exhibited loss of interdental papilla in the area of tooth number 11 and 21 caused by presence of gingivitis and poor brushing techniques. The patient was assessed according to Nordland and Tarnow classification in order to ascertain the procedure's degree of predictability; she was additionally examined according to Cardaropoli classification in order to be able to establish pre- and post-treatment comparisons. The patient exhibited 5 mm of contact point to the bone crest, therefore, HA infiltration was undertaken into the papilla, every seven days for four weeks. Conclusion: There are very few non-surgical techniques to regenerate interdental papillae, one of them is HA use. Research conducted on this technique is not new, nevertheless, it would be suitable to further it taking into consideration different factors; conducting them in greater-sized populations with subjects of different ethnicities and gender, and using different infiltration intervals.

Comparative morphometric study of the filiform lingual papilla in the middle east blind mole rat (Spalax ehrenbergi, Nehring, 1898) and Wistar albino rat / Estudio morfométrico comparativo de la papila lingual filiforme en la rata topo ciega del medio oriente (Spalax ehrenbergi, Nehring, 1898) y la rata albino Wistar

This study aimed to reveal the morphometric differences between blind mole rats which live under ground and rats which live under laboratory conditions with regard to the length, base width, keratinization thickness and microscopic papilla depth. For this purpose, 7 adult blind mole rats and 7 adult Wistar albino rats were used in the study. All tongues were removed and fixed in 10 % neutral formalin. 4-5 micrometer of sections were obtained from paraffine sections which were obtained with routine histological follow ups and Crossman's modified triple staining was applied. While papilla length was found as 184.73±26.68 µm, base width 65.46±16.51 µm, keratinization thickness 11.60±1.37 µm, microscopic papilla depth 49.89±8.19 µm in blind rats; these values were found as 177.49±31.44 µm, 50.08±7.57 µm, 13.08±5.32 µm and 89.12±19.31 µm, respectively in rats. While a statistically significant difference was not detected between lengths (p>0.05), the difference between papilla width was found significant (p<0.05). While keratinization was found to be thicker on posterior side compared to anterior side in both species, a difference was not detected between keratinization thickness measurements (p>0.05). The difference between two species with regard to papilla depth was detected to be significant (p<0.001). The finding that papilla depth decreases as base width increases and the difference's being statistically significant suggested that living in different environments with different humidity could be effective on morphologic structures of the tongue in blind mole rats and rats.

Este estudio tuvo como objetivo revelar las diferencias morfométricas de las papilas linguales filiformes entre ratas topo ciegas que viven bajo tierra y ratas que viven en condiciones de laboratorio, con respecto a la longitud, ancho de la base, espesor de la queratinización y profundidad microscópica de las papilas. Para este propósito, se utilizaron 7 ratas topo ciegas adultas y 7 ratas albinas Wistar adultas. Se retiraron las lenguas y se fijaron en formalina neutra al 10 %. Se obtuvieron secciones de 4 a 5 µm a partir de técnicas histológicas de rutina, aplicándose la tinción triple modificada de Crossman. En las ratas topo ciegas se obtuvieron los siguientes datos morfométricos en relación a las papilas linguales filiformes: longitud 184,73 ± 26,68µm, ancho de la base 65,46 ± 16,51 µm, espesor de queratinización 11,60 ± 1,37 µm, profundidad microscópica de la papila 49,89 ± 8,19 µm, mientras que en las ratas control, los valores que se encontraron fueron 177,49 ± 31,44 µm, 50,08 ± 7,57 µm, 13,08 ± 5,32 µm y 89,12 ± 19,31 µm, respectivamente. Si bien no se detectó diferencia estadísticamente significativa entre las longitudes (p> 0,05), la diferencia del ancho de la papila fue significativa (p <0,05). Mientras que la queratinización fue más gruesa en la parte dorsal comparado con la parte ventral en ambas especies, no se detectó diferencia entre las mediciones de espesor de la queratinización (p> 0,05). Se detectó que la diferencia entre las dos especies con respecto a la profundidad de la papila era significativa (p <0,001). Se determinó que la profundidad de la papila disminuye a medida que aumenta el ancho de la base y la diferencia es estadísticamente significativa, lo que sugiere que vivir en diferentes ambientes con diferente humedad podría ser eficaz en las estructuras morfológicas de la lengua de ratas topo ciegas y de ratas de laboratorio.

Colangiopancreatografía asistida por laparoscopia en bypass gástrico y fistulotomía pre-corte por cálculo impactado en papila / Colangiopancreatography Assisted by Laparoscopy in Gastric Bypass and Fistulotomy Pre-Cut by Calculation Impacted in Papila

La denominada cirugía bariátrica “Bypass Gástrico” es una de las operaciones bariátricas mayormente efectuadas a nivel mundial y en aumento en años recientes. La exclusión del estómago y duodeno, después del procedimiento, deja con gran dificultad, la ejecución vía oral, de la Colangiopancreatografía endoscópica (CPRE) y el acceso al tracto biliar y pancreático. Debido a la incrementada incidencia de litiasis biliar en pacientes luego del procedimiento “bypass gástrico”, habrá más requerimiento de la Colangiopancreatografía endoscópica. En los últimos años se ha demostrado que los pacientes con bypass gástrico que ameriten evaluar el tracto biliopancreático pueden someterse exitosamente a Colangiopancreatografía endoscópica terapéutica transgástrica asistida por laparoscopia, en forma segura y confiada. Presentamos nuestra paciente con litiasis residual: cálculo impactado en la papila, efectuando la Colangiopancreatografía endoscópica transgástrica asistida por laparoscopia e Fistulotomía con bisturí - aguja por cálculo impactado en la papila, resuelto satisfactoriamente.

The “Gastric Bypass” is one of the most performed bariatric operatio ns worldwide, and in recent years the number of former bypass patients accrues. The gastric bypass excludes the stomach and duodenum, and it makes very difficult, by oral route, the access to the biliopancreatic tract, by means the endoscopic retrograde cholangiopancreatography (ERCP). Due to the increased evidence of gallstones after bariatric operations, the ERCP could be more often required. In recent years, it has been demostrated that gastric bypass patients can be successfully evaluated endoscopically by laparoscopic transgastric ERCP, as a safe and reliable method. We describe a patient with residual billiary impacted stone in the papilla, who underwent laparoscopic transgastric ERCP and a precut “fistulotomy” technique with needle - knife, was highly successful, without add significant morbidity to the procedure.

Desprendimiento seroso macular asociado a foseta papilar congénita y coloboma de papila: ¿Qué opciones terapéuticas tenemos? / Macular serous detachment associated to congenital papillary pit and papillary coloboma: What treatment options do we have?

La foseta papilar es una rara anomalía congénita que forma parte del espectro de las anormalidades congénitas del disco óptico. Se trata de invaginaciones intrapapilares que suelen localizarse en el margen del disco óptico. La mayoría se localiza a nivel temporal; en torno al 20 por ciento son de localización central seguidas por las fosetas superiores, inferiores o nasales. La bilateralidad se estima en un 10-15 por ciento y su incidencia se ha establecido en torno al 0,19 por ciento. Suelen ser asintomáticas, aunque en aproximadamente el 50 por ciento de los casos se produce afectación macular por el paso de fluido procedente desde la foseta papilar hacia las diferentes capas retinianas, lo que afecta secundariamente la agudeza visual y es, por tanto, el motivo de consulta. Hasta el momento se han descrito múltiples alternativas terapéuticas para el tratamiento de los desprendimientos de retina serosos asociados a foseta de papila, pero ninguna de estas alternativas se ha impuesto sobre el resto. El tratamiento de esta enfermedad consiste en cerrar la comunicación entre la foseta y el espacio subretiniano con diversas opciones terapéuticas como: la fotocoagulación láser, la neumoretinopexia, la indentación escleral posterior, la fenestración del nervio óptico, la vitrectomía o alguna combinación de las anteriores. La actual revisión bibliográfica se propone profundizar en el tema, sobre la base de pacientes en consulta con dicha afección retiniana(AU)

Papillary pit is a rare congenital anomaly that is part of the congenital optic disc anomaly spectrum. It deals with intrapapillary invaginations that may be located at the border of the optic disc. Most of them is located at temporal level, around 20 percent are located centrally followed by upper, lower and nasal pits. Bilateral pits are estimated to be 10-15 percent and their incidence has been set at 0.19 percent. They are asymptomatic although 50 percent of cases suffer macular damage due to the passing of fluid from the papillary pit to the different retinal layers, which affecgs in a secondary way the visual acuity and thus it is the reason to go to the ophthalmologist. Multiple therapeutic alternatives for the treatment of papillary pit-associated serous retinal detachments have been described but none of them has predominated over the others. The treatment of this disease consists of closing the communication between the pit and the subretinal space with several therapeutic options such as laser photocoagulation, pneumoretinopexia, posterior scleral indentation, optic nerve fenestration, vitrectomy or any combination of the above-mentioned methods(AU)

Reconstrucción de la papila gingival alrededor del implante mediante técnica novedosa / Papilla reconstruction around the implant using novel technique

La reconstrucción de la estética gingival (rosada) es un tema importante en la odontología implanto-soportada moderna, y cualquier resultado estético comprometido se considera un fracaso. En la literatura se proponen variados enfoques quirúrgicos y no quirúrgicos para reconstruir la papila interdental perdida. En esta técnica modificada, el extremo distal del injerto pediculado fue dividido en dos partes creando una estructura bífida, que luego se colocó alrededor del pilar y suturó por vestibular. Esta técnica dio como resultado un aumento significativo de volumen de la papila en las direcciones coronaria y vestibular. El injerto de tejido conectivo pediculado subepitelial asociado con un colgajo coronalmente desplazado parece ser un abordaje viable para el tratamiento de la papila ausente, asociado con restauraciones implanto-soportadas.

Rebuilding the pink esthetic is an important issue in modern esthetic implant dentistry, and any compromised esthetic results following implant-supported restorations are considered failures. Several surgical and nonsurgical approaches are proposed in the literature to reconstruct the lost interdental papilla. In this modified technique the distal end of the pedicle graft was divided into two parts creating a bifid, which were then placed around the abutment and sutured on the facial aspect. This technique resulted in a significant gain of papillary volume in both coronal and facial directions. The subepithelial connective pedicle graft associated with a coronally advanced flap seems to be a viable approach for the treatment of missing papilla associated with implant-supported restorations.

Absence of interdental papilla ­ Systematic review of available therapeutic modalities / Ausência de papila interdental ­ revisão sistemática sobre as modalidades terapêuticas disponíveis

The objective of the present study was to conduct a systematic review of the treatment alternatives for the absence of interdental papilla (AIP), a clinical situation that can have aesthetic and phonetic impacts. A search for original articles, in humans, reporting more than one case, without language restrictions, dealing with therapeutic alternatives for AIP, was conducted in the databases of MEDLINE and EMBASE. The strategy included [("interdental papilla" OR "black triangles" OR "open gingival embrasure") AND ("treatment" OR "therapy" OR "reconstruction")] up to the year of 2010, resulting in seven studies being included. One study was found upon checking the reference lists and was added, bringing the total to 8 studies. The sample size ranged from two to 19 participants. Six of the eight studies used periodontal surgical techniques and fi ve associated the subepithelial connective tissue graft. Two studies treated AIP with reticulated hyaluronic acid gel. The follow-up time ranged from four to 24 months. The results, in relation to the interdental space area, ranged from 43% to 100% of fi lling and the reduction of the distance between the contact point and the tip of the papilla ranged from 0.73 to 2.8 mm. Two studies did not describe the results numerically. It was concluded that the therapeutic results presented by the authors were positive. However, it is necessary to take into consideration that the designs of the studies included here have a weak capacity for generating scientifi c evidence. As studies with a randomized clinical trial design are not conducted to respond to this clinical question, the results of the present study should be used with caution.

O objetivo deste estudo foi realizar uma revisão sistemática sobre as alternativas de tratamento da ausência da papila interdental (API), situação clínica que pode trazer impactos estéticos e fonéticos. Uma busca por artigos originais, em humanos, apresentando mais de 1 caso, sem restrição de idiomas, que tratassem sobre alternativas terapêuticas para a API foi realizada nas bases de dados Pubmed e Embase. A estratégia incluiu: [("interdental papilla" OR "black triangles" OR "open gingival embrasure") AND ("treatment" OR "therapy" OR "reconstruction")] a partir do ano de 2010, resultando em sete estudos incluídos. Um estudo foi encontrado na verifi cação das listas de referências e adicionado, totalizando 8 estudos. O tamanho amostral variou de dois a 19 participantes. Seis dos oito estudos utilizaram técnicas cirúrgicas periodontais e cinco associaram o enxerto conjuntivo subepitelial. Dois estudos trataram a API com gel de ácido hialurônico reticulado. O tempo de acompanhamento variou de quatro a 24 meses. Os resultados em relação ao espaço/área interdental variaram de 43 a 100% de preenchimento e a redução da distância entre o ponto de contato e a ponta da papila variou de 0,73 a 2,8 mm. Dois estudos não descreveram numericamente os resultados. Conclui-se que os resultados terapêuticos apresentados pelos autores foram positivos. Entretanto, é preciso levar em consideração que o delineamento dos estudos incluídos tem fraca capacidade de gerar evidência científi ca. Enquanto estudos com delineamento do tipo ensaio clínico randomizado não sejam realizados para responder essa pergunta clínica, os resultados do presente estudo devem ser utilizados com cautela.

Reabilitação estética cirúrgica com preservação de papilas / Surgical aesthetic rehabilitation with papillae preservation ­ a case report

O aumento cirúrgico de coroa com finalidade estética é uma técnica bastante utilizada para restabelecer dimensões adequadas para a harmonia do sorriso, que pode ser realizada por meio da técnica cirúrgica de osteotomia com posicionamento apical do retalho. Mas, a técnica convencional pode promover a falta de proporcionalidade entre largura e altura das coroas, além de "buracos negros" interproximais, condições que levam ao fracasso na obtenção da estética. Neste relato de caso, será demonstrada uma variação no desenho do retalho para execução de osteotomia, para aumento estético da coroa clínica de incisivos superiores, no qual os efeitos indesejados supracitados são eliminados. A técnica proposta é realizada por incisões nas quais as papilas e o osso interproximal são preservados, e possibilita o acesso à tábua óssea vestibular para confecção da osteotomia. Portanto, a previsibilidade e a estabilidade dos resultados são aumentadas, assim como a satisfação do paciente. Uma paciente do sexo feminino compareceu à clínica de Periodontia da Faculdade de Odontologia de Bauru/USP queixando-se de desconforto ao sorrir, por considerar seus dentes curtos e com excesso de exposição gengival. O exame clínico atestou ausência de sinais de inflamação e ampla faixa de gengiva ceratinizada. O procedimento de aumento cirúrgico das coroas clínicas com preservação da papila inter- dental foi proposto. O controle de 14 meses de acompanhamento comprovou que a aplicação da técnica conservadora sugerida apresentou um resultado estético estável e uma recuperação previsível, demonstrando ser uma ferramenta vantajosa no tratamento cirúrgico de coroas clínicas curtas.

Crown lengthening with aesthetic purposes is a widely used technique for restoring dimensions suitable for smile harmony, which can be accomplished by surgical osteotomy with flap apical positioning. But the conventional technique can promote the lack of proportionality between crown width and height, as well as interproximal "black spaces", conditions that lead to compromised esthetics. For these factors, in this case report we demonstrate a variation in the flap design for osteotomy with esthetic clinical crown lengthening of the upper incisors, in which the undesired effects are eliminated. The proposed technique uses incisions that preserve the papillae and interproximal bone and provides access to the buccal bone plate for osteotomy. Therefore, predictability and stability of the results is increased, as well as patient satisfaction. A female patient attended the Periodontology clinic, Bauru School of Dentistry/USP complaining of discomfort while smiling due to her short clinical crowns and excessive dental displaying. The clinical examination attested absence of signs of inflammation and wide range of keratinized gingiva and the crown lengthening procedure with preservation of interdental papilla was proposed and expressly accepted by patient. Fortheen months later, it was demonstrated that the application of the suggested conservative technique showed stable aesthetic results and a predictable recovery, proving to be an advantageous tool for the surgical treatment of short clinical crowns.

Tratamiento de recesión única de clase III con injerto libre subepitelial mediante técnica de colgajo de doble papila reposicionado: informe de un caso clínico / Treatment of a single Class III recession combining free subepithelial connective tissue graft and a double papilla repositioned flap: report of a clinical case

Objetivo: mostrar y evaluar los resultados clínicos de un procedimiento de cirugía plástica periodontal, efectuada para cubrir una recesión radicular de clase III de Miller, con una técnica bilaminar. Además, analizar el aumento de la banda de encía y el cambio de biotipo gingival de la pieza dentaria. Caso clínico: paciente femenino de 30 años de edad, con una recesión gingival de Clase III de Miller por vestibular de la pieza 43 que no sobrepasa la línea mucogingival, con pérdida interproximal de tejidos duros y blandos. El tratamiento consiste en un colgajo de doble papila a espesor parcial, con injerto libre subepitelial tomado del paladar, con seguimiento a 1 año. Conclusiones: la técnica bilaminar es una solución viable en casos de recubrimiento radicular poco predecibles, como la recesión de clase III de Miller. El biotipo gingival se vio engrosado y la encía queratinizada no sufrió variaciones.

Topografia da papila parotídea em Cerdocyon thous (Linnaeus, 1766) e Lycalopex gymnocercus (G. Fisher, 1814)

Objetivou-se determinar o local de desembocadura do ducto excretor da glândula salivar parótida nos canídeos silvestres Cerdocyon thous e Lycalopex gymnocercus e, assim, fornecer subsídios para procedimentos em medicina veterinária e estudos de anatomia comparada. Para tal, foram inspecionadas as papilas parotídeas de 28 cadáveres (56 hemiarcadas) recolhidos mortos em rodovias: C. thous (cinco machos e nove fêmeas) e L. gymnocercus (nove machos e cinco fêmeas). A partir da papila parotídea traçou-se uma linha imaginária vertical para determinar sua correspondência topográfica em relação aos dentes pré-molares (P) e molares (M). Dois cadáveres de cada espécie foram dissecados para determinação macroscópica da posição da glândula parótida e respectivo ducto. A glândula localizou-se ventralmente à cartilagem auricular e seu ducto apresentou trajeto sobre a face lateral do m. masseter, abrindo-se no vestíbulo oral. Quando consideradas as hemiarcadas, no C. thous houve predominância da abertura do ducto no nível entre P4 e M1 (53,6% dos casos), seguida pela abertura oposta a M1 (46,4%). Os machos de C. thous apresentaram local de desembocadura do ducto em nível significativamente (p-valor = 0,0006) mais caudal do que as fêmeas. No L. gymnocercus em metade das hemiarcadas a abertura ocorreu entre P4 e M1 e na outra metade opostamente a M1, não havendo diferença significativa entre se

Neoformação de papila gengival com ácido hialurônico: relato de caso

Introdução: a papila interdentária é a porção gengival que ocupa o espaço entre dois dentes adjacentes e a ausência dessa estabelece espaços interdentais denominados black spaces, causando desconforto, impacção alimentar e problemas estéticos e fonéticos. A etiologia da recessão da papila interdental é multifatorial, podendo ou não estar associada às doenças periodontais ou ao tratamento dessas. Objetivo: este estudo tem como objetivo avaliar a eficiência do ácido hialurônico como material indutivo à formação de papila gengival, visando ao preenchimento das ameias interdentais por novo tecido gengival. Relato de caso: paciente branco, 53 anos, gênero masculino, apresentando durante exame clínico perda de papila interdentária na arcada superior, abrangendo os elementos dentários 13, 12, 11, 21, 22 e 23. A saúde bucal dos demais elementos dentários estava em boas condições. Logo após exame clínico e fotografias, foram realizadas aplicações de ácido hialurônico (Perfectha Derm, Obvieline Laboratoire, France) para preenchimento do black space interpapilar. Considerações finais: o ácido hialurônico demonstrou eficácia e biocompatibilidade com os tecidos, obtendo resultados satisfatórios quanto à sua aplicação. A aplicação como material de preenchimento injetável revelou ser de grande importância para casos de grande perda de papila interdentária, demonstrando ser um mé- todo simples, seguro e eficaz.

Stem cells from the apical papilla versus periodontal ligament stem cells：biological behaviors / 中国组织工程研究

BACKGROUND:Stem cels from the apical papila are a new kind of mesenchymal stem cels, and whether it can be used in root regeneration is the key to the present study. OBJECTIVE:To culture rat stem cels from the apical papila and periodontal ligament stem celsin vitro, and to compare the biology behaviors of these two kinds of cels, thereby providing experimental basis for the application of stem cels from the apical papila in root regeneration. METHODS:The apical papila, as wel as the periodontal ligament tissues from the healthy mandibular teeth of young rats were digested and cultured. Immunophenotypes of stem cels from the apical papila and periodontal ligament stem cels were detected by immunofluorescence technique. Then, cel growth curves were determined by MTT method and mineralized nodule formation was observed by alizarin red staining. RESULTS AND CONCLUSION:Stem cels from the apical papila and periodontal ligament stem cels were both positive for STRO-1. Stem cels from the apical papila were positive for CD90 and weakly positive for CD146. Periodontal ligament stem cels were positive for CD146 and weakly positive for CD90. The absorbance values of stem cels from the apical papila and periodontal ligament stem cels increased with the increasing of time and became stable at 8 days. Since the 4th day, the proliferation capacity of stem cels from the apical papila was significantly stronger than that of periodontal ligament stem cels (P < 0.05). Both of stem cels are visible to have mineralized nodule formation. Compared with the periodontal ligament stem cels, stem cels from the apical papila were stained obviously deeper and had more mineralized nodules. These results show that stem cels from the apical papila have stronger proliferation capacity and mineralization ability than periodontal ligament stem cels. Cite this article:Zhao L, Yu L, Yuan P, Zhou CM, Wu PL.Stem cels from the apical papila versus periodontal ligament stem cels: biological behaviors. Zhongguo Zuzhi Gongcheng Yanjiu. 2016;20(1):113-117.

Parámetros mucogingivales y dentarios en estudiantes de odontología chilenos / Mucogingival and dental parameters in Chilean dental students

Fueron analizados los parámetros de proporción dentaria, posición del cénit gingival, posición y tamaño de las papilas interdentarias, biotipo gingival, cantidad de encía queratinizada y línea de la sonrisa en las 6 piezas anterosuperiores en 31 estudiantes de odontología chilenos. Se estableció un patrón de proporción dentaria similar al descrito previamente en la literatura. La posición de cénit presentó un patrón definido. El biotipo gingival fino fue el más frecuente. Los incisivos laterales presentaron la mayor cantidad de encía queratinizada, seguidos por los incisivos centrales y luego los caninos. La altura de la papila a nivel de los caninos fue mayor que en los incisivos centrales, mientras que los valores más bajos fueron encontrados a nivel de los incisivos laterales. Existió una predominancia de la línea de la sonrisa media.

Tooth proportion, gingival zenith position, position and size of the interdental papillae, gingival biotype, amount of keratinized gingiva and smile line position were evaluated in the 6 upper front teeth in 31 Chilean dental students. The tooth proportion pattern was similar to that described previously in the literature. The zenith position showed an established pattern. A thin gingival biotype was found more frequently. Lateral incisors showed the highest amount of keratinized tissue, followed by central incisors and then the canines. The height of the papillae at the canines was higher than central incisors, while the lowest values were found in the lateral incisors. There was a predominance of a medium smile line.

Paciente con íctero intermitente como forma de presentación de un adenoma de papila duodenal / A Patient with Recurrent Jaundice as Presentation of an Adenoma of Duodenal Papilla

Los tumores duodenales son menos frecuentes que los del estómago y colon. Los habituales son los carcinomas, linfomas y tumores de los estromas malignos o benignos; los pólipos duodenales suelen ser asintomáticos. Su manifestación más frecuente es la hemorragia. Las lesiones de gran tamaño pueden cursar con un cuadro suboclusivo y las periampulares producir ictericia. Se presentó el caso de una paciente de 68 años de edad, colecistectomizada que ingresa por íctero intermitente, con episodios de coluria, acolia, prurito generalizado, pérdida de peso y dolor en epigastrio, se realizó ecografía de hígado, vías biliares y páncreas en la cual se evidenció dilatación de vías biliares, se exploró endoscópicamente el duodeno y se observó una lesión sobreelevada se le realizó biopsia, diagnosticándose un adenoma de papila duodenal. La paciente fue sometida a una ampulectomía, no se observó focos de adenocarcinoma en la biopsia quirúrgica y el cuadro ictérico desapareció, no se presentaron complicaciones postoperatorias.

Duodenal tumors are less frequently than those of stomach and colon. The habitual ones are carcinomas, lymphomas and malignant or bening stromal tumors, duodenal polyps are usually asymptomatic. The haemorraghe is the most frequent sign. The great size lesions can show a suboclussive presentation and the periampullary ones can produce. A 68-year-old female patient to whom cholecystectomy was performed was presented in this article. The patient was admitted due to recurrent jaundice, episodes of dark urine, acholia, generalized pruritus, weight loss and epigastric pain. Ultrasonography of the liver, biliary tract and pancreas was performed in which bile duct dilatation was evident, duodenum was also explored and a lesion was observed. Biopsy was done and an adenoma of duodenal papilla was diagnosed. Surgical ampulectomy was performed without adenocarcinoma findings in the surgical biopsy, the jaundice disappeared and none postsurgical complication was observed.