RT-qPCR study of COX-1 and -2 genes in oral surgical model comparing single-dose preemptive ibuprofen and etoricoxib: A randomized clinical trialy.

BACKGROUND: This study aimed to evaluate the gene expression of cyclooxygenases (COXs) in an oral model of preemptive analgesia. MATERIAL AND METHODS: Gingival tissue was collected during extraction of lower third molars from a randomized, triple-blind, split-mouth and placebo-controlled study. The eligible patients were randomly sorted to receive a single dose either of ibuprofen 400mg, or etoricoxib 120 mg or a placebo, one hour prior to surgery. The temporal course of RNAm was evaluated for COX-1 and -2 by means of a quantitative polymerase chain reaction in real time (RT-qPCR) at time zero and 30 minutes after the surgical procedure began, and it was correlated with clinical parameters (pain and maximum mouth opening). RESULTS: There was a significant increase in COX-1 expression between T0 and T30 in ibuprofen (p=0.004) and etoricoxib (p=0.010) groups. As regards COX-2, there were increases from T0 to T30 in all groups (placebo, p=0.012; ibuprofen, p<0.001; etoricoxib, p<0.001). All groups showed a significant decrease in COX-2:COX-1 ratio from T0 to T30 (placebo, p=0.013; ibuprofen, p<0.001; etoricoxib, p=0.047). Experimental groups showed a significant correlation between COX-1 and COX-2 levels and clinical pain parameters. CONCLUSIONS: The present preemptive analgesia study concludes that COX-2 RNAm induction was directly linked to third molar-related tissue inflammation and that the relation between COX-1 and COX-2 levels were inversely proportional to the preemptively administered nonsteroidal anti-inflammatory drugs COX-2 selectivity. Key words:Preemptive analgesia, dental extraction, cyclooxygenases, real-time polymerase chain reaction.

Lesión bucal relacionada con relleno dérmico / Dermal filler-related oral lesion

Introduction: Oral adverse reactions related to natural dermal fillers may originate from infiltration techniques, giving rise to swellings, nodule formation doe to local material entrapment, or displacement or migration of the material used. Objective: describe a case of orofacial foreign body reaction in an elderly patient. Case report: a 65-year-old woman was referred for oral evaluation complaining of an intraoral lesion present for 15 days. Intraoral examination revealed a mobile nodule in the lower lip left portion. After the initial consultation, incisional biopsy was performed under local anesthesia and the surgical specimen was sent for histopathological analysis. Intraoral examination revealed a soft mobile nodule in the lower lip left portion. Clinical pathological and Raman microspectroscopy analysis led to a final diagnosis of calcium hydroxyapatite dermal filler-related reaction. Conclusions: this case reinforces the possibility of dermal filler-related mucosal tissue reactions in oral cavity soft tissues(AU)

Introducción: las reacciones adversas bucales relacionadas con rellenos dérmicos naturales pueden originarse a partir de técnicas de infiltración, lo que ocasiona inflamaciones, formación de nódulos por atrapamiento de material local o desplazamiento o migración del material usado. Objetivo: describir un caso de reacción a cuerpo extraño bucofacial en un adulto mayor. Presentación del caso: una mujer de 65 años de edad fue remitida para evaluación bucal por presentar una lesión intrabucal durante 15 días. El examen intrabucal reveló un nódulo móvil en la porción izquierda del labio inferior. Después de la consulta inicial, se realizó una biopsia incisional bajo anestesia local y se envió la muestra quirúrgica para su análisis histopatológico. El examen intrabucal reveló un nódulo móvil suave en la porción izquierda del labio inferior. El análisis clínico-patológico y de la micro-espectroscopia de Raman condujeron a un diagnóstico final de reacción de hidroxiapatita cálcica relacionada con el relleno dérmico. Conclusiones: este caso refuerza la posibilidad de reacciones cutáneas relacionadas con los rellenos dérmicos en los tejidos mucosos de la cavidad bucal(AU)

Effects of Pterygomaxillary Separation on Skeletal and Dental Changes After Surgically Assisted Rapid Maxillary Expansion: A Single-Center, Double-Blind, Randomized Clinical Trial.

PURPOSE: Surgically assisted rapid maxillary expansion (SARME) is a procedure routinely performed to correct transverse maxillary deformities and can be performed with or without pterygomaxillary disjunction (PD). The aim of the present study was to measure the effect of the amount of expansion and stability of SARME with or without PD. PATIENTS AND METHODS: We designed and implemented a double-blind, randomized clinical trial. The patients were randomly assigned to 2 groups: group 1, SARME without PD; and group 2, SARME with PD. Cone-beam computed tomography scans were performed at 3 points: baseline (T0), after maxillary expansion (T1), and at the end of the retention period (T2). Dental and bone expansion and dental inclination at the maxillary canine and first molar regions were assessed. Two-way repeated measures analysis of variance was used to evaluate the differences between the 2 groups at the 3 evaluation periods (T0, T1, and T2), using a level of significance of P < .05. RESULTS: A total of 24 patients underwent maxillary surgical expansion (group 1, n = 12; and group 2, n = 12). Both techniques promoted a significant transverse dental expansion in the first molar at T2 (with PD, 5.4 mm; vs without PD, 6.4 mm; change, -6.18 mm to 1.48 mm). However, no statistically significant differences were observed between the 2 groups. The tipping molars at T2 remained at a higher level in the SARME, no PD group than in the SARME, PD group (with PD, 2.3°; vs no PD, 4.6° for 3 teeth; change, -12.72° to 5.57°; and with PD, 1.6° vs without PD, 3.6° for 14 teeth; change, -9.96° to 9.83°). CONCLUSIONS: SARME with and without PD is a reliable method for obtaining maxillary expansion, with slight differences in the patterns of skeletal and dental alterations.

The use of Le Fort I Approach in the resection of an extensive ossifying fibroma.

INTRODUCTION: Ossifying fibroma (OF) is a well-defined benign neoplasm characterized by slow growth and predilection for the posterior mandible site, usually treated by conservative surgical approaches. In this context, Le Fort I Approach (LFIA) has been increasingly used providing good visualization and an easy access to the lesion. It also allows removal of the lesion quickly. Although there are case reports using LFIA for the management of benign neoplasms, odontogenic cysts and tumors of the middle third of face, to our knowledge, only one article describes the use of surgical LFIA for OF of the maxilla. Thus, the objective of this study was to report the second paper on the use of horizontal osteotomy of the maxilla in the resection of an extensive OF and conduct a brief literature review on this surgical approach. CASE REPORT: The following case report describes a 33-year-old man who was diagnosed with OF. Oral examination showed a painless swelling of hard consistency, covered by normal mucosa in edentulous alveolar ridge of the maxillary posterior region of the right side. Tomographic slices revealed that the image with mixed density had a centrifugal growth, with expansion of the buccal and lingual cortical with an upper displacement of the maxillary sinus. The patient was admitted to the hospital for surgical resection of the lesion via LFIA. Satisfactory functional results were obtained after 18-month follow-up period. In addition, no recurrence or clinical complaints were noted. DISCUSSION: LFIA shall be considered as a feasible option when planning surgery for removal of extensive benign lesions located in midfacial region because it is a predictable technique and routinely performed by the oral and maxillo-facial surgeons.

Ránulas intraorales en una población brasileña: estudio retrospectivo del empleo de la marsupialización modificada / Intraoral ranulas in a brazilian population: a retrospective study of the use of modified marsupialization

Las ránulas son seudoquistes resultantes de la extravasación salival de las glándulas sublinguales. Diversos tratamientos han sido empleados, no obstante, la marsupializaión se ha demostrado es el método más utilizado. La modificación de la técnica convencional, haciendo un taponamiento con gasas medicadas, presenta bajos índices de recurrencia, mientras su aplicación cuidadosa. El objetivo de este trabajo fue evaluar los resultados obtenidos por el empleo de la técnica de marsupialización modificada en los casos de ránulas intraorales diagnosticadas en el Servicio de Estomatología de la Facultad de Odontología de la Universidade Federal do Ceará, entre marzo de 1999 a diciembre de 2010, y comparar estos datos con estudios previamente reportados en la literatura. Los datos, tras su colecta, fueron tabulados y analizados estadísticamente (SPSS, versión 17.0). Del total de 2.103 biopsias, 17 (0.8%) correspondieron a ránulas intraorales, con edad comprendida entre 10 y 34 años de edad (media de 22,9 años), siendo 82,4 mujeres y 17,6 hombres. El tamaño de las lesiones varió entre 0,3 y 4 cm, con un promedio de aproximadamente 1,8 cm. La técnica de marsupialización modificada empleada en 13 pacientes, presentó un solo caso de recidiva. Otras dos recurrencias fueron observadas cuando se utilizó la técnica de la extirpación de la lesión, usada en cuatro casos. Nuestros resultados mostraron que la marsupialización, con cambio de la técnica convencional, es un método conservador eficaz, aunque no estadísticamente significativo (p>0,05), debiendo ser elegido como primera opción en el tratamiento de ránulas intraorales, con tasas reducidas de recurrencia.

Ranulas are pseudocysts as a result of salivary extravasation of the sublingual glands. Various treatments have been used, however, has been shown marsupialization the most used. The modification of the conventional technique, carefully filling of the lesion with gauze soaked in nitrofurazone (Furacin ®), have low rates of recurrence. The aim of this study was to evaluate the results obtained using the technique of marsupialization modified in the treatment of intraoral ranulas diagnosed in the Service of Stomatology, Faculty of Dentistry at the Universidade Federal do Ceará, from March 1999 to December 2010, and compare these data with previously reported studies in the literature. The data, after collection, were tabulated and statistically analyzed (SPSS, version 17.0). Of the total of 2,103 biopsies, 17 (0.8%) were intraoral ranulas, aged between 10 and 34 years of age (mean 22.9 years), with 82.4 men and 17.6 women. The lesion size ranged from 0.3 to 4 cm, with an average of about 1.8 cm. Modified marsupialization technique used in 13 patients, presented a single case of recurrence. Two other recurrences were observed when using the technique of surgical excision, used in four cases. Our results showed that marsupialization, with change of the conventional technique is an effective conservative approach, although not statistically significant (p> 0.05), must be chosen as first choice in the treatment of intraoral ranulas, with reduced rates of recurrence.

Histomorphometric assessment of bone necrosis produced by two cryosurgery protocols using liquid nitrogen: an experimental study on rat femurs

OBJECTIVE: The aim of this study was to evaluate the effects of liquid nitrogen cryosurgery on the femoral diaphysis of rats. MATERIAL AND METHODS: The femoral diaphyses of 42 Wistar rats were exposed to three local and sequential applications of liquid nitrogen for 1 or 2 min, intercalated with periods of 5 min of passive thawing. The animals were sacrificed after 1, 2, 4 and 12 weeks and the specimens obtained were processed and analyzed histomorphometrically. RESULTS: The depth and extent of peak bone necrosis were 124.509 µm and 2087.094 µm for the 1-min protocol, respectively, and 436.424 µm and 12046.426 µm for the 2-min protocol. Peak necrosis was observed in the second experimental week with both cryotherapy protocols. CONCLUSIONS: The present results indicate that the 2-min protocol produced more marked bone necrosis than the 1-min protocol. Although our results cannot be entirely extrapolated to clinical practice, they contribute to the understanding of the behavior of bone tissue submitted to different cycles of liquid nitrogen freezing and may serve as a basis for new studies.

Worldwide incidence of odontogenic tumors.

PURPOSE: The objective of the study was to determine the relative frequency of odontogenic tumors (OTs) in the world population, directing an epidemiologic profile to these lesions. METHODS: Was conducted a search in epidemiologic studies involving OTs that are listed by PubMed and Ovid, EMBASE, and Cochrane Library, embracing the period from January 1960 to January 2010, to verify their incidence worldwide. We identified 195 articles, of which 19 articles were selected, considering the location, age, sex, histologic type, and World Health Organization classification. RESULTS: A total of 8544 OTs were found. The results showed a low frequency of malignant OTs in selected works. The most frequent tumor was ameloblastoma (39.6%), followed by odontoma (20.1%) and the newly included keratocystic OT (13.8%). CONCLUSIONS: These OTs are uncommon lesions in world population, and malignant OTs are very rare. The relative frequency of different kinds of OTs, the age, and the sex distribution show a marked geographic variation in incidence of those lesions. This was particularly notable in the ameloblastomas and odontoma, with the incidences being relatively well and weighted showing similar values to an average when compared with previous studies.

Maxillary cementoblastoma in a child.

Cementoblastoma is a rare benign tumor that almost always occurs in the premolar or molar region and more commonly in the mandible than in the maxilla. We present a unique incisor maxillary cementoblastoma in an 11-year-old child not previously described. To our knowledge, only 2 maxillary cases, both related to canine teeth, were described in the international literature. Thus, the aim of this article was to discuss the clinical presentation, diagnosis, and subsequent treatment of a patient with a cementoblastoma in the anterior maxillary region.

Assessment of the oral and maxillofacial surgery service in a teaching hospital in Brazil.

OBJECTIVE: The purpose of this study was to determine an epidemiologic profile of the patients hospitalized and/or operated on by an oral and maxillofacial surgery service in Brazil. MATERIALS AND METHODS: A retrospective and descriptive epidemiologic survey of the Oral and Maxillofacial Surgery Service from Saint Lucas Hospital at the Pontifical Catholic University, Porto Alegre, Brazil, from January 2000 to December 2005, was performed. Data related to the number, sex, age, service year, as well as surgical modalities performed, instituted treatments, and length of stay, were collected from the hospital's handbooks. RESULTS: A total of 1117 patients were attended during the 6 years of study, with a decreasing tendency throughout the years (P = 0.022). There was female predominance (54%), between 10 and 40 years old, and attended via public health system (56%). Among surgical modalities performed, dentoalveolar surgery was the most prevalent (22.9%), followed by the orthognathic surgeries (21.4%), facial fractures (18%), pathologic condition surgeries (16.7%), and dental implants and grafts (13.7%). Surgeries of patients with cleft lip and/or palate (3.4%), treatment of maxillofacial infections (2.95%), and temporomandibular joint surgeries (1%) were less frequent. CONCLUSIONS: The information presented in this research elicited data to clarify the type of attendance performed by the service, being a cornerstone for planning, organization, and attention improvement of these patients. In addition, this information can compare with data among services, specialty acting fields, as well as, its impact in hospital activities.

Histomorphometric assessment of bone necrosis produced by two cryosurgery protocols using liquid nitrogen: an experimental study on rat femurs.

OBJECTIVE: The aim of this study was to evaluate the effects of liquid nitrogen cryosurgery on the femoral diaphysis of rats. MATERIAL AND METHODS: The femoral diaphyses of 42 Wistar rats were exposed to three local and sequential applications of liquid nitrogen for 1 or 2 min, intercalated with periods of 5 min of passive thawing. The animals were sacrificed after 1, 2, 4 and 12 weeks and the specimens obtained were processed and analyzed histomorphometrically. RESULTS: The depth and extent of peak bone necrosis were 124.509 µm and 2087.094 µm for the 1-min protocol, respectively, and 436.424 µm and 12046.426 µm for the 2-min protocol. Peak necrosis was observed in the second experimental week with both cryotherapy protocols. CONCLUSIONS: The present results indicate that the 2-min protocol produced more marked bone necrosis than the 1-min protocol. Although our results cannot be entirely extrapolated to clinical practice, they contribute to the understanding of the behavior of bone tissue submitted to different cycles of liquid nitrogen freezing and may serve as a basis for new studies.

Oral lipomas in a Brazilian population: a 10-year study and analysis of 450 cases reported in the literature.

OBJECTIVES: Lipomas are common benign mesenchymal neoplasms that rarely occur in the oral cavity and correspond to less than 4.4% of all benign oral soft tissue tumors. This study describes the clinical, radiological and histological features of cases of oral lipomas seen over a period of 10 years and compared the findings with those reported in the literature. STUDY DESIGN: All cases of oral lipomas seen between 1999 and 2009 were retrieved from the archives of the Stomatology Division of the Federal University of Ceará, Brazil. Age, gender, tumor location, clinical findings, duration, histological subtypes, and treatment outcome were recorded. In addition, the English-language literature was searched for studies published between 1966 and 2009. RESULTS: Ten patients (6 women and 4 men) were enrolled in this study. The mean age was 53.4 years (range: 21- 73 years). The specific sites involved were the oral mucosa (n=5), vestibule (n=3), gingiva (n=1), and retromolar region (n=1). The mean size of the tumors was 1.94 cm (range 1.0 to 3.0 cm). Radiographically, only one case appeared as a radiolucent area on occlusal film. Microscopically, 4 cases were classified as simple lipoma, 4 as fibrolipoma, 1 as myxoid lipoma, and 1 as angiolipoma. The duration of the tumors ranged from 2 to 84 months, with a mean duration of 30.4 months. All cases were treated by simple surgical excision and there was no recurrence after a mean post-treatment period of 34.5 months. The findings were compared with 450 cases of oral lipomas reported in the literature. CONCLUSIONS: Lipomas continue to be an uncommon neoplasm of the oral cavity. Radiography is a valuable tool due to the possible occurrence of bone involvement. Surgical excision is the treatment of choice and recurrence is not expected.

Síndrome de Ardência Bucal: relatos de casos / Burning Mouth Syndrome: and cases report

A Síndrome de Ardência Bucal (SAB), de etiologia multifatorial, é uma condição na qual os pacientes apresentam-se com generalizada sensação de ardor ou dor na boca, mas não existem anormalidades prontamente reconhecidas na mucosa bucal. É uma dosordem intra-bucal comum que afeta mais as mulheres. A ardência pode ocorrer em muitos sítios dentro ou a redor da cavidade bucal. São reconhecidos três tipos na SAB. O objetivo deste trabalho é realizar uma revisão da literatura acerca da SAB e relatar dois casos clínicos.

Xerostomia: diagnóstico e implicações clínicas / Xerostomia: diagnostic and clinical implications

Xerostomia constitui-se em uma sensação subjetiva de secura bucal. O diagnóstico baseia-se em sua história, no exame da cavidade bucal e na avaliação da função salivar. A partir de sua identificação, diversas condutas podem ser seguidas como: controle sintomático, estimulação tópica e sistêmica da secreção salivar. O objetivo do trabalho é nortear os profissionais de Odontologia quanto ao diagnóstico, etiologia, epidemiologia, sinais e sintomas, métodos de quantificação do fluxo salivar e formas de controle dessa enfermidade, uma vez que não é curável atualmente por nenhum método terapêutico

Amiloidose lingual associada à hemodiálise de longa duração: relato de caso / Lingual amyloidosis associated to long-term hemodialysis: report of a case

A amiloidose representa uma situação clínica resultante do depósito de proteína amilóide nos espaços extracelulares de órgãos e tecidos, a qual pode coexistir sem causar nenhuma anormalidade ou produzir sérias conseqüências ao organismo. Geralmente, é classificada em uma variante limitada a órgãos e uma forma sistêmica. Embora apenas raramente possa envolver os tecidos orais, o cirurgião-dentista deve reconhecer as suas manifestações clínicas para ajudar no tratamento ou interromper a sua progressão. O propósito deste trabalho é relatar o caso de uma paciente que apresentava depósitos de amilóide na língua causados por uma hemodiálise de longa duração

Extenso mixoma odontogênico de maxila: relato de caso e considerações cirúrgicas / Extensive odontogenic myxoma of maxilla: case report and surgical considerations

O mixoma odontogênico é uma neoplastia benigna, porém localmente invasiva, oriunda do mesênquima primitivo. O objetivo deste trabalho é relatar um extenso caso de mixoma odontogênico na maxila, ressaltando aspectos importantes que guiaram a escolha da técnica cirúrgica e do tipo de reconstrução empregados

Osteorradionecrose - Relato de um caso / Osteoradionecrosis - Report of case

A osteorradionecrose é uma das mais sérias complicações da radioterapia de cabeça e pescoço, onde o osso afetado torna-se hipovascularizado, hipóxico e hipocelular, ou seja, mais susceptível ao desenvolvimento de infecções e necrose. O propósito deste trabalho é relatar o caso de um paciente portador de osteorradionecrose mandibular conseqüente a mandibulotomia para acesso de uma neoplasia maligna em região amigdaliana.