Clinical and Histological Effects of Calcium Hydroxyapatite Filler in the Orofacial Region: A Study in Rats.

BACKGROUND: Calcium hydroxyapatite (CaHA) dermal filler has been increasingly used in facial aesthetic procedures. OBJECTIVE: To investigate clinical and histological changes associated with calcium hydroxyapatite (CaHA) dermal filler in the orofacial region. MATERIALS AND METHODS: Forty-eight female Wistar rats were divided into CaHA and control groups. The material was applied in the ventral tongue and the submandibular region; the animals were euthanized after 7, 30, and 90 days. RESULTS: After 7 days, yellowish nodules with a firm consistency were observed on the tongue. In 2 animals, the material migrated to the base of the tongue. Histopathological examination revealed CaHA spheres surrounded by an infiltrate, predominantly composed of macrophages. In the CaHA group, the percentage of collagen in the tongue and dermis was higher compared with the control group (p < .05) at both 30 and 90 days. The thickness of the epidermis/dermis was also higher in the CaHA group (p < .05). In 5 submandibular glands containing material, areas of edema and hyperemia were observed, along with infiltrates of neutrophils, lymphocytes, and plasma cells. Changes in the morphology of ducts and acini in adjacent regions were evident. CONCLUSION: CaHA exhibits satisfactory properties for filling and collagen biostimulation in the tested regions. Further studies are required to explore the potential for migration and the glandular alterations.

Effect of tyrosine kinase inhibitor sunitinib on tissue repair at tooth extraction sites.

BACKGROUND: Both zoledronic acid, a potent bisphosphonate, and the antiangiogenic drug sunitinib are included in anticancer protocols and have also been associated with jaw osteonecrosis. Our aim was to compare the effect of these drugs on tissue repair at tooth extraction sites. METHODS: Wistar rats were allocated into four groups: (1) sunitinib; (2) sunitinib/zoledronic acid; (3) zoledronic acid; (4) control group. The animals underwent tooth extractions and maxillae were macro- and microscopically analyzed. RESULTS: On macroscopic evaluation, the zoledronic acid group showed a significantly higher frequency of oral mucosal lesion; lesions in the sunitinib/zoledronic acid group were larger, albeit not significantly so. The sunitinib/zoledronic acid group had significantly less epithelium than the zoledronic acid and control group, but showed no significant difference compared to the sunitinib group. The sunitinib/zoledronic acid and zoledronic acid groups did not differ from each other, but had significantly less connective tissue and more non-vital bone and microbial colonies than sunitinib and control groups, whereas these latter two groups did not significantly differ from each other. Vital bone and inflammatory infiltrate did not significantly differ between groups. CONCLUSION: Sunitinib alone is not associated with non-vital bone, whereas the sunitinib/zoledronic acid combination and zoledronic acid alone are.

Autogenous dentin combined with mesenchymal stromal cells as an alternative alveolar bone graft: an in vivo study.

OBJECTIVE: Considering the chemical and structural properties of dentin, this study was aimed at evaluating the effect of dentin matrix alone or combined with mesenchymal stromal cells (MSC) on postextraction alveolar bone regeneration. MATERIAL AND METHODS: Wistar rats were subjected to tooth extraction with osteotomy and allocated into groups according to the graft inserted: (1) Gelita-Spon®, (2) Bio-Oss®, (3) Dentin, (4) MSC, (5) Dentin/MSC, and (6) Control. Maxillae were analyzed by means of hematoxylin and eosin (H&E) staining, immunohistochemical (IHC) analysis, microcomputed tomography (micro-CT), and scanning electron microscopy (SEM). Serum levels of calcium and phosphorus were quantified. RESULTS: The Bio-Oss group showed less bone than Gelita-Spon and Dentin/MSC; no other significant differences were seen in H&E analysis. The Bio-Oss group showed higher expression of collagen type I compared to the Dentin and Dentin/MSC groups and also higher osteocalcin expression than the Dentin/MSC group. There was a tendency of higher expression of osteopontin in the MSC, Dentin, and Dentin/MSC groups and higher VEGF in the MSC group. On micro-CT analysis, the Bio-Oss and the Dentin/MSC groups exhibited greater bone volume than the Control. Serum calcium and phosphorus levels did not significantly differ between the groups. SEM analysis depicted particles of Bio-Oss and dentin in the respective groups, as well as significant cellularity in the MSC group. CONCLUSION: Autogenous nondemineralized dentin is an alternative for alveolar bone grafting, which can be improved by combination with MSC. CLINICAL RELEVANCE: This work provides support for the clinical applicability of dentin graft alone or combined with MSC.

Laser photobiomodulation does not alter clinical and histological characteristics of 4-NQO-induced oral carcinomas and leukoplakia in mice.

OBJECTIVE: This study evaluated the effect of laser photobiomodulation (PBM) on oral leukoplakia and squamous cell carcinomas (OSCC) in a model of oral carcinogenesis. MATERIALS AND METHODS: Forty-one C57Bl/6 female mice were distributed in control group, 4-NQO group, Laser group 1.5 J and Laser group 9 J. Oral cancer was induced on the tongue by nitroquinoline oxide (4-NQO), diluted in the water for 16 weeks. In the 18th and 19th weeks, PBM with a diode laser, 0.028 cm2 spot size, continuous emission mode, 660 nm wavelength was applied on the tongue of animals for seven sessions. Laser group 1.5 J received 30 mW power and 1.5 J energy. In the Laser group 9 J, 100 mW power, and 9 J energy were applied. In the 20th week the animals were euthanized. RESULTS: All animals exposed to carcinogen developed clinical and histological alterations such as leukoplakia and OSCC on the tongue. There was no significant difference among Laser groups 1.5 and 9 J and 4-NQO group (not irradiated) regarding the area of leukoplakia and carcinomas (P > 0.05) or thickness of epithelial tissue and keratin (P > 0.05). There were also no association between PBM and histologic classification of the lesions (P = 0.87), frequency of OSCC (P = 0.57), grade of tumor differentiation (P = 0.88) or depth of invasion (P = 0.45). CONCLUSION: Laser PBM, in both parameters used, does not influence on clinical and histological characteristics of oral leukoplakia and OSCC. CLINICAL RELEVANCE: Results suggest that PBM may be a safe treatment for adverse effects of antineoplastic therapies in patients with leukoplakia and OSCC.

Adverse effects of deoxycholic acid in submandibular glands, submental, inguinal and subplantar regions: a study in rats.

OBJECTIVE: We aimed to evaluate the effects of the deoxycholic acid (DCA) in the submental and subplantar regions of rats, and to histologically analyze the changes caused in the submandibular glands, soft tissues of the paw, and inguinal adipose tissue. MATERIAL AND METHODS: Sixty male Wistar rats were divided into DCA and control (CG) groups. DCA was injected in the submental, inguinal, and subplantar regions, and saline was injected in the CG. The animals were euthanized after 24 h and at 7 and 21 days. RESULTS: The DCA group showed edema in the submental region in 24 h and in the paw in all experimental times. In the paw there were also erythema and ulceration in 7 days, and alopecia after 21 days. At 21 days, a few animals also showed erythema and ulceration in paw; however, there was no significant difference from CG. Histological analysis of the paw showed an intense inflammatory process, with a predominance of neutrophils, lymphocytes, and plasma cells in 24 h and 7 days. In the adipose tissue, we observed loss of architecture and inflammatory infiltrate, followed with a lower number of adipose cells, and at 21 days, fibroplasia. In the submandibular glands we observed inflammatory infiltration, loss of tissue architecture, and fibrosis. CONCLUSIONS: DCA produces a significant inflammatory process in the structures. It can cause skin ulcerations and, in salivary glands, it causes loss of tissue architecture and fibrosis. CLINICAL RELEVANCE: There has been growing increase in the use of DCA for aesthetic purposes by health care providers. Due to the presence of important anatomical structures in the submental region, constant vigilance is required to report new adverse effects.

Repercussions of osteoporosis on the maxillofacial complex: a critical overview.

INTRODUCTION: We present here a literature review focusing on the repercussions of osteoporosis on the oral and maxillofacial complex. Osteoporosis is a silent metabolic disorder characterized by reduced bone mineral density (BMD), which can lead to bone fractures, particularly affecting elderly women. The prevalence of this disease has increased significantly worldwide, and since it accelerates bone resorption also in the jaw bones, some attention has been paid to possible oral and maxillofacial manifestations. MATERIALS AND METHODS: The databases PubMed and Google Scholar were searched for reports of oral and maxillofacial changes related to osteoporosis. RESULTS: Several parameters evaluating bone changes in panoramic radiography have been proposed to estimate osteoporosis-related BMD loss, but they tend to warn about the possibility of osteoporosis, rather than being diagnostic criteria. Meanwhile, it seems that osteoporosis-related BMD loss could delay alveolar bone healing and potentiate bone loss in periodontal disease. CONCLUSION: Even though orofacial bones are not compromised by osteoporosis as much as the axial/appendicular skeleton, a regular dental follow-up of osteoporotic patients is advised, especially in the case of periodontal disease and maxillofacial surgery. Further controlled longitudinal studies considering the site-specificity of osteogenesis would be helpful regarding this issue.

Morphological and immunohistochemical features of tooth extraction sites in rats treated with alendronate, raloxifene, or strontium ranelate.

OBJECTIVE: The aim of this study was to evaluate morphological and immunohistochemical features of tooth extraction sites in rats subjected to different antiresorptive drugs. MATERIALS AND METHODS: Wistar rats were allocated into 4 groups according to the treatment: (1) alendronate, (2) raloxifene, (3) strontium ranelate, and (4) control. The animals underwent tooth extraction (60th day of treatment) and afterwards were euthanized (90th day of treatment). Tooth extraction sites were analyzed by means of scanning electron microscopy (SEM), hematoxylin-eosin staining (H&E), and immunohistochemical staining (RANKL and OPG). RESULTS: On H&E analysis, the alendronate group showed greater amounts of non-vital bone, biofilm, inflammatory infiltrate and root fragment, and smaller amount of vital bone. The strontium ranelate group showed great amount of non-vital bone. This group also had lower levels of OPG, while the alendronate group showed lower OPG and RANKL than the other groups. On SEM analysis, the alendronate group showed a considerable number of microcracks on the alveolar bone surface and few Howship lacunae and lack of bone cells as well. The raloxifene, strontium ranelate, and control groups showed a large number of bone cells and Howship lacunae on the bone surface and few microcracks. CONCLUSION: Alendronate therapy is associated with macro- and microscopic features of medication-related osteonecrosis of the jaw at tooth extraction sites, whereas raloxifene therapy is not, and strontium ranelate therapy is associated with non-vital bone. CLINICAL RELEVANCE: Osteonecrosis of the jaws is a serious side effect of alendronate therapy, where tooth extraction is a major risk factor. Considering the significant number of patients undergoing antiresorptive therapies worldwide, the present study investigated whether raloxifene and strontium ranelate interfere with bone repair after tooth extraction in a similar way to bisphosphonates.

Salivary Gland Tumors: a Ten-Year Retrospective Analysis in a Brazilian Teaching Hospital / Tumores de las Glándulas Salivales: Análisis Retrospectivo de Diez Años en un Hospital de Enseñanza Brasileño / Tumores de Glândulas Salivares: Análise Retrospectiva de Dez Anos em um Hospital Escola Brasileiro

Introduction: The tumors affecting salivary glands have a wide morphological diversity. Objective: This study aimed to examine the prevalence of salivary gland tumors in patients treated at São Lucas Teaching Hospital at the Pontifical Catholic University of Rio Grande do Sul (HSL-PUCRS), in Porto Alegre (RS), Brazil, from 2007 to 2016. Method: A retrospective study analyzing 201 files from the Department of Pathology at the HSL-PUCRS was carried out, by revising the medical records. Results: Seventy-three cases of salivary gland tumors were found, and their electronic and physical medical records were analyzed. Of the 73 cases, 56 (76.7%) were benign tumors and 17 (23.3%) were malignant tumors. The age group with the highest number of cases was between 41 and 60 years of age and the highest prevalence was found in females, with 54.8% of the cases. The parotid gland presented the highest prevalence, accounting for 72.6% of the cases. The predominant neoplasia was the pleomorphic adenoma, accounting for 53.4% of the tumors. The standard of distribution of neoplasms of salivary glands was similar to the encountered in other Brazilian regions. Conclusion: The largest salivary glands were the most affected by neoplastic processes. Pleomorphic adenoma and adenoid cystic carcinoma were the most frequent benign and malignant tumors, respectively, and parotid gland was the most affected site. In the light of previous literature data, the results allow to infer that some demographic characteristics (for example, sex and age) vary among the different geographic regions

Introducción: Los tumores que afectan a las glándulas salivales tienen una amplia diversidad morfológica. Objetivo: Identificar la prevalencia de neoplasias de glándulas salivales en pacientes atendidos en el Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (HSLPUCRS), en Porto Alegre (RS), desde 2007 hasta 2016. Método: Estudio retrospectivo mediante el análisis de 201 registros del Departamento de Patología de HSL-PUCRS. Resultados: Se encontraron 73 casos de neoplasias de glándulas salivales y se analizaron los registros electrónicos y físicos de los casos seleccionados. De los 73 casos, 56 (76,7%) fueron de neoplasias benignas y 17 (23,3%) de neoplasias malignas. El grupo de edad con mayor número de casos fue el de 41 a 60 años, y la mayor prevalencia en mujeres, con 54,8%. La glándula parótida tuvo una mayor prevalencia, constituyendo 72,6% de los casos. El tipo neoplásico más prevalente fue el adenoma pleomorfo, con 53,4%. El patrón de distribución de las neoplasias de glándulas salivales fue similar al encontrado en otras regiones de Brasil. Conclusión: Las glándulas salivales mayores fueron las glándulas más afectadas por procesos neoplásicos. El adenoma pleomórfico y el carcinoma adenoide quístico fueron los tumores benignos y malignos más frecuentes, respectivamente y el sitio más afectado fue la glándula parótida. Con base en la literatura previa, estos resultados permiten inferir que algunas características demográficas (por ejemplo, sexo y edad) varían entre las distintas regiones geográficas

Introdução: Os tumores que afetam as glândulas salivares apresentam vasta diversidade morfológica. Objetivo: Identificar a prevalência de neoplasias de glândulas salivares em pacientes atendidos no Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (HSL-PUCRS), em Porto Alegre (RS), no período de 2007 a 2016. Método: Estudo retrospectivo por meio da análise de 201 arquivos do Departamento de Patologia do HSL-PUCRS. Resultados: Foram encontrados 73 casos de neoplasias de glândulas salivares e os prontuários eletrônicos e físicos dos casos selecionados foram analisados. Dos 73 casos, 56 (76,7%) eram de neoplasias benignas e 17 (23,3%) de neoplasias malignas. A faixa etária com maior número de casos foi entre 41 e 60 anos e o sexo feminino apresentou a maior prevalência com 54,8%. A glândula parótida apresentou maior prevalência, perfazendo 72,6% dos casos. O tipo neoplásico mais prevalente foi o adenoma pleomórfico, com 53,4%. O padrão de distribuição das neoplasias de glândulas salivares foi semelhante ao encontrado em outras Regiões do Brasil. Conclusão: As glândulas salivares maiores foram as mais afetadas pelos processos neoplásicos. Adenoma pleomórfico e carcinoma adenoide cístico foram os tumores benignos e malignos mais frequentes, respectivamente, e a glândula parótida foi o local mais acometido. Com base na literatura prévia, esses resultados permitem inferir que algumas características demográficas (por exemplo, sexo e idade) variam entre as diferentes Regiões geográficas

Cervicofacial actinomycosis: important considerations on a mimicking disease / Actinomicosis cervicofacial: consideraciones importantes sobre una enfermedad imitadora

SUMMARY Actinomycosis is a rare chronic suppurative infection that affects upper airways and the gastrointestinal tract. The aim of this work was to review important information regarding the etiopathogenesis, clinical features and treatment of cervicofacial actinomycosis. According to the anatomic site affected, it is classified into three clinical forms: cervicofacial (50%), thoracic (30%) and abdominal (20%). We present here a literature review focusing on important aspects of cervicofacial actinomycosis. Despite the name comprising the term mycosis, the disease is caused by Gram-positive bacteria of the genus Actinomyces, mainly Actinomyces israelii, which are commensals of the oral microbiota. Nevertheless, when the integrity of the oral mucosa is compromised, they can become pathogenic. Actinomycosis evolves slowly and it often mimics other clinical conditions such as malignancies. Treatment consists in antibiotic therapy and can last up to 12 months in severe cases. Health care professionals' knowledge about the disease is crucial in a way to promote its prevention, early diagnosis and proper treatment.

RESUMEN La actinomicosis es una enfermedad infecciosa muy infrecuente de tipo crónico y supurativo que afecta al área cervicofacial e el tracto gastrointestinal. El presente trabajo tuvo como objetivo, revisar informaciones importantes en cuanto etiopatogenia, presentación clínica y tratamiento de la actinomicosis cervicofacial. Se puede clasificar de tres maneras a depender del sitio anatómico: cervicofacial (50%), torácica (30%) y abdominal (20%). Presentamos una revisión de la literatura con foco en aspectos importantes de la actinomicosis cervicofacial. Aunque se le denomine micosis, la enfermedad es causada por bacterias grampositivas del género Actinomyces, siendo que A. israelli es el agente etiológico más frecuente, cuales son microorganismos comensales de la boca. Sin embargo, si la integridad de la mucosa es violada, ellos se tornan patogénicos. La actinomicosis es lentamente progresiva y frecuentemente imita otras condiciones clínicas como malignidades. El tratamiento consiste en terapia antibiótica y puede durar 12 meses en casos más graves. El conocimiento de los profesionales de salud acerca de esa enfermedad es fundamental para promover su prevención, diagnóstico precoz y tratamiento correcto.

Gardner syndrome with maxillofacial manifestation: A case report.

Gardner syndrome is a hereditary disease in which patients develop gastrointestinal polyps, osteomas, desmoid tumors, epidermoid cysts, fibromas, lipomas, and retinal lesions. Dental abnormalities such as supernumerary or impacted teeth, odontomas and dentigerous cysts are also reported. The most serious concern in this syndrome is the extremely high risk of gastrointestinal polyps undergoing malignant transformation. Since the maxillofacial findings usually precede gastrointestinal polyps, the dentist plays a crucial role in the diagnosis of Gardner syndrome, and panoramic radiography is an important tool in the diagnosis of the disease. We report here a case of Gardner syndrome in a patient showing mandibular osteomas and impacted teeth. Also, cases of Gardner syndrome with maxillofacial manifestations reported in the literature were reviewed and compared with ours. According to the findings, osteomas are important manifestations of this syndrome, and regardless of the absence of family history of intestinal polyposis, their occurrence should prompt diagnostic evaluation for this disease.

Brown tumor of the jaws as a manifestation of tertiary hyperparathyroidism: A literature review and case report.

Brown tumor of the jaws is a manifestation of hyperparathyroidism consisting of osteolytic lesions that show proliferation of multinucleated giant cells in the maxilla and/or mandible. Differential diagnosis of these lesions from local central giant-cell granuloma is mandatory for the correct treatment of the patient. Radiographic and histopathological exams of the jaw lesion are not sufficient to determine the diagnosis, which requires laboratory tests including serum levels of calcium, alkaline phosphatase, parathyroid hormone (PTH) and phosphate, and radiographic examination of other bones as well, such as hand-wrist, pelvis, and femur. We present here a brief literature review focusing on the clinical and radiographic features, diagnostic criteria and treatment of brown tumor and also report a case of the disease affecting the jaw.

Interrelationship of clinical, radiographic and haematological features in patients under bisphosphonate therapy.

OBJECTIVES: To analyze the clinical, radiographic and haematological aspects of patients under bisphosphonate therapy. METHODS: A retrospective study was conducted where the records of patients taking bisphosphonates were analyzed considering the occurrence of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Evaluation included panoramic and periapical radiographies, haematological examinations and clinical features. Radiographies were analyzed determining the presence or absence of bone sclerosis, osteolysis, persisting alveolar socket, narrowing of the mandibular canal, widening of the periodontal ligament space, periradicular radiolucency, sequestrum and thickening of the lamina dura. Laboratory tests consisted of complete blood count, fasting serum glucose, erythrocyte sedimentation rate (ESR) and serum levels of calcium, phosphorus, alkaline phosphatase, parathormone (PTH) and C-terminal telopeptide of collagen I (CTX). RESULTS: Alkaline phosphatase and ESR were significantly higher in the BRONJ group, whereas fasting serum glucose, CTX, PTH, calcium and phosphorus did not significantly differ. BRONJ showed association with smoking, tooth extraction, anaemia and leukocytosis. On radiographic analysis, persisting alveolar socket, osteolysis, bone sclerosis and narrowing of the mandibular canal were significantly more prevalent in the BRONJ group. Thickening of the lamina dura, periapical radiolucencies, widening of the periodontal ligament space and sequestrum did not significantly differ between the groups. CONCLUSIONS: BRONJ is a multifactorial disease with high morbidity, which requires experimental studies to clarify the role of the reported risk factors and clinical radiographic signs to improve its diagnosis.

Bisphosphonate-related osteonecrosis of the jaw: from the sine qua non condition of bone exposure to a non-exposed BRONJ entity.

The present work aimed to review the literature focusing on the diagnostic criteria for bisphosphonate-related osteonecrosis of the jaw (BRONJ) and its implications regarding the management of the disease. Since the report of the first cases, BRONJ concepts, diagnostic criteria and guidelines have been changed. The presence of bone exposure in the oral cavity was at first a sine qua non condition for diagnosis. However, it seems that the great concern now is the possibility of occurrence of BRONJ without this feature. Some authors warn that the bone exposure criterion leads to late diagnosis and poor response to treatment. Meanwhile, some radiographic features, such as bone sclerosis, have been postulated as early signs of the disease. Criticisms have also been raised about the clinical staging system of BRONJ. While there is no consensus on the subject, common sense recommends treating symptomatic patients taking bisphosphonate as having BRONJ despite the absence of bone exposure; and asymptomatic patients must be kept under dental follow-up, since all of them are at risk for BRONJ.