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Language Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2022. Vol. 27, no. 2
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- Investigation of the prevalence of impacted third molars and the effects of eruption level and angulation on caries development by panoramic radiographs(2022) Yildirim, Handan; Büyükgöze-Dindar, MedihaThis study is aimed to determine the prevalence of impacted third molars and to investigate the effects of their eruption level and angulation on caries formation in the distal of the adjacent tooth. This cross-sectional study was conducted on panoramic radiographs of 38481 patients who were admitted to the Trakya University, Faculty of Dentistry. The panoramic radiographs of 7998 patients with at least one impacted third molar were included. Third molars were classified according to Winter?s classification and Pell and Gregory?s classification. The frequency of caries in partially impacted third molars and adjacent second molars was determined. The chi-square tests were used to determine potential associations between the third molars' level of eruption, angulation, and caries development. The study group consisted of 4423 females (55.3%) and 3575 males (44.7%) with a mean age of 36.3±13.4 years. The prevalence of the third molar impaction rate was 23%. The impaction pattern of partially erupted third molars was characterized by an eruption level of A with the vertical position in both jaws. Partially erupted and vertically placed maxillary third molars in the level of position A caused more caries in the adjacent tooth and mesioangularly located partially erupted mandibular third molars were associated with more caries in the adjacent tooth. The angulation and eruption level of partially erupted third molars should be carefully examined. The prophylactic extraction of vertically and mesioangularly located third molars, especially with an eruption level of position A can be suggested to eliminate the related complications and risk of caries.
- MutSa expression predicts a lower disease-free survival in malignant salivary gland tumors:an immunohistochemical study(2022) do Amaral-Silva, Gleyson Kleber; Dias, Laryssa Moura; Mariz, Bruno A.L.A.; Fonseca, Felipe Paiva; Ayroza Rangel, Ana Lúcia Carrinho; Zanella, Virgilio Gonzales; Castilho, Rogerio M.; Martins, Manoela D.; Vargas, Pablo Agustín; Wagner, Vivian PetersenAppropriate DNA replication is vital to maintain cell integrity at the genomic level. Malfunction on DNA repair mechanisms can have implications related to tumor behavior. Our aim was to evaluate the expression of key complexes of the DNA mismatch-repair system MutS? (hMSH2-hMSH6) and MutS? (hMSH2-hMSH3) in a panel comprising the most common benign and malignant salivary gland tumors (SGT), and to determine their association with disease-free survival. Ten cases of normal salivary gland (NSG) and 92 of SGT (54 benign and 38 malignant) were retrieved. Immunohistochemistry was performed for hMSH2, hMSH3, hMSH6. Scanned slides were digitally analyzed based on the percentage of positive cells with nuclear staining. Cases were further classified in MutS?high and MutS?high based on hMSH2-hMSH6 and hMSH3-hMSH6 expression, respectively. hMSH3 expression was lower in malignant SGT compared to NSG and benign cases. Adenoid cystic carcinoma (ACC) cases with perineural invasion presented a lower percentage of hMSH3 positive cells. hMSH6 was downregulated in both benign and malignant SGT compared to NSG. Malignant SGT cases with MutS?high expression had lower disease-free survival compared to MutS?low cases. A 10.26-fold increased risk of presenting local recurrence was observed. Our findings suggest that a lack of hMSH3 protein function is associated with a more aggressive phenotype (malignancy and perineural invasion) and that MutS? overexpression predicts a poor clinical outcome in malignant SGT.
- Can cystic lesions of the jaws be considered as the cause of mandibular asymmetry?(2022) Polat, Mevlüde; Odabasi, OnurThe aim of this study is to investigate the presence of condylar and ramal asymmetry in patients with a cyst larger than 10 mm in the maxilla or mandible. Condylar and ramal asymmetry index measurements of 47 patients (mean age: 28.85 ± 15.348) in the study group and 40 patients in the control group (mean age: 33.73 ± 13.095) were performed using panoramic radiographs. The study group consists of patients with cysts larger than 10 mm in diameter in the maxilla or mandible. The control group consisted of patients with no radiolucent lesions and no history of trauma. The possible statistical difference between the groups was evaluated by the Mann-Whitney U test. No statistically significant difference was observed in asymmetry indices according to gender and the jaw (maxilla or mandible) in which the cyst was located. However, it was determined that CAI and RAI values were statistically significantly different between the study and control groups (p = 0.047 and p = 0.016, respectively). The presence of intraosseous cysts larger than 10 mm in the jaws was found to be associated with condylar and ramal asymmetry.
- A randomized clinical trial of topical dexamethasone vs. cyclosporine treatment for oral lichen planus(2022) Georgaki, Maria; Piperi, Evangelia; Theofilou, Vasileios I.; Pettas, Efstathios; Stoufi, Eleana; Nikitakis, Nikolaos G.Oral lichen planus (OLP) is a common, frequently symptomatic, immune-mediated disease. Various treatments have been used for symptomatic OLP, including corticosteroids and immunosuppressants administered topically or systemically. The aim of this study was to compare the effectiveness of topical dexamethasone vs. topical cyclosporine in treatment of symptomatic OLP. Thirty-two patients with biopsy-proven symptomatic OLP were randomly assigned to two therapeutic groups: dexamethasone 2mg/5ml or cyclosporine 100mg/ml, both administered topically in a swish and spit method three times a day for 4 weeks. The patients were followed up for a total of 6 months. Assessed parameters included clinical scoring (according to Thongprasom?s scale, 0-5), pain (VAS scale, 0-10), dysphagia and speech difficulties (none, mild or severe). Possible side effects, including fungal overgrowth, were also recorded. At the end of the 4-week treatment period, both dexamethasone and cyclosporine showed a statistically significant improvement in clinical scoring (p<0.025 and p=0.034, respectively), which was better with dexamethasone (p=0.001). In addition, both dexamethasone and cyclosporine induced statistical significant improvement in pain and dysphagia (and speech difficulties for dexamethasone), without significant differences between the two groups. Regarding side effects, patients in the dexamethasone group developed candidiasis more frequently compared to cyclosporine (p=0.031). At the end of the 6-month follow-up period, the difference in response between the two groups was not statistically significant. Interestingly, a trend for further improvement compared with the end of the 4-week treatment period was noticed only for patients treated with cyclosporine. Despite the small number of enrolled patients, topical cyclosporine treatment induces a significant clinical improvement in symptomatic OLP patients, which, compared to topical dexamethasone, appears to be less pronounced during initial administration, but capable to induce further improvement after discontinuation with a satisfactory long-term remission in the absence of significant side effects. This study may contribute to a better understanding of the differences in effectiveness of OLP topical treatments and guide future larger scale clinical trials.
- Prevalence and morphometric analysis of the retromolar canal in a Spanish population sample:a helical CT scan study(2022) Puche-Roses, Miguel; Blasco Serra, Arantxa; Valverde Navarro, Alfonso A.; Puche Torres, M.The retromolar canal (RMC) is an anatomical variation of the mandibular canal (MC) whose identification and study should be considered given its implication in the surgical procedures of the retromolar area. The prevalence of the RMC widely varies according to previous studies and may be influenced by the followed study method. This work aimed to evaluate the prevalence of the RMC in a Spanish population sample. For this purpose, 225 CT scan images (with a higher resolution than the cone beam CT used in other previous studies) from the Hospital Clínico Universitario de Valencia were analyzed. The Osirix MD® radiological image analysis system was applied to analyse the dimensions, location in the retromolar area and morphologic characteristics of the RMC by classifying them according to their typology. Furthermore, the relations between the RMC and gender, age and laterality were studied. RMC prevalence was 23.1%. No significant relation between the presence of the canal and gender, age or laterality was found. Type Ia was the commonest type with a prevalence of 40.8%. Based on the results of this study, the RMC should be considered a frequent anatomical variation whose complete study is very important in daily clinical practice.
- Reliability of the pre-operative imaging to assess neck nodal involvement in oral cancer patients, a single-center study(2022) Pakkanen, Antti L; Marttila, Emilia; Apajalahti, Satu; Snäll, Johanna; Wilkman, TommyPrimary sites for the metastasis of oral cancer are the cervical lymph nodes. Although there has been considerable technical advancement in the radiological imaging, capability to recognize all metastatic lymph nodes pre-operatively has remained as a challenge. Thus elective neck dissection (END) has remained as reliable practice to treat cervical lymph nodes. This study evaluated the accuracy of pre-operative imaging in pre-operative diagnostics of cervical lymph node status using computed tomography or magnetic resonance imaging in patients with oral squamous cell carcinoma (OSCC). We have also considered the reasons for the difficulties to recognise metastatic nodes in cervical area. Patient charts of patients who had had elective neck dissection as a treatment for primary OSCC in the Department of Oral and Maxillofacial Surgery, Helsinki University Hospital between 2016 and 2017 were assessed retrospectively. The outcome variable was post-operatively histologically confirmed lymph node metastasis in the neck area. The primary predictor variable was radiologically confirmed metastasis in the neck area. The explanatory variables were age, sex, pT-class, imaging modality, delay and location of the tumour. Descriptive statistics, sensitivity, specificity and Youden-J index were computed. Eighty-three patients were included in the study. The sensitivity to detect pathological lymph nodes was 44.8%, and the specificity for the examination was 87.0%. 19.3% of cN0 patients had metastasis in the cervical nodes, whereas of the cN+ patients 8.4% were actually pN0. Patients having cN0, the largest neck metastasis was over 10 mm in 12.5%, whereas cN1-3 patients the corresponding rate was 45.5%. The computational threshold to diagnose a metastatic node was 7 mm. Especially small metastases are difficult to diagnose. Limitations of radiological diagnostics must be considered when treating OSCC.
- Hypovitaminosis D, oral potentially malignant disorders, and oral squamous cell carcinoma:a systematic review(2022) Maturana Ramírez, Andrea; Aitken Saavedra, Juan; Ladrón de Guevara Benítez, Arantxa; Espinoza Santander, IrisOral squamous cell carcinoma (OSCC) and potentially malignant oral disorders (OPMDs) could be associated with low levels of vitamin D. This systematic review aimed to determine the relationship between serum levels of vitamin D with OPMDs and OSCC. This review was conducted according to Cochrane guidelines (PROSPERO CRD42020207382) on literature retrieved from the PubMed, Cochrane, and Web of Science databases. The antecedents extracted were study design, methodology, sample (country, number of patients, age, and sex), oral manifestations (type of lesion, location, prevalence, and follow-up), serum vitamin D levels or use of vitamin D supplements, results, and conclusions. Twelve articles were selected. Some of the most relevant findings were alterations in vitamin D could favor the progress of OPMDs to OSCC. Higher levels of vitamin D can increase levels of anti-inflammatory mediators, CD4+ T lymphocytes and CD8+ T lymphocytes and CD3+ T lymphocytes in intratumoral tissue. The normalization of vitamin D levels in patients with OSCC can increased cytotoxic activity of natural killer cells, favoring antitumor immune response. Vitamin D supplemented can lower adverse effects associated with chemotherapy like mucositis and pain. Tobacco can increase risk of developing OSCC altering vitamin D levels. Hypovitaminosis D could increase risk of developing OSCC from OPMDs, thus altering the immune response and it is associated with a lower survival rate in patients with OSCC, a greater recurrence of tumors in patients who underwent surgical treatment, and an increase in adverse reactions to chemotherapy. The use of vitamin D supplements can be a complement to primary therapy to prevent the recurrence of lesions and reduce adverse events associated with treatment.
- Prognostic importance of DNA from human papillomavirus in patients with oral squamous cell carcinoma(2022) Perez, Elizabeth; García Carrancá, Alejandro; Acosta Gío, Enrique; Reynoso Noverón, Nancy; Maldonado Martínez, Héctor A.; Guido-Jiménez, Miriam; Sobrevilla-Moreno, Nora; Granados García, Martín; Pérez-Báez, Wendy B; Vilar Compte, DianaSurvival of patients with oral squamous cell carcinoma (OSCC) is generally low, with the likelihood of locoregional recurrence or disease progression (LR/DP). Knowledge of prognostic factors for survival is key to achieving an understanding and increased survival. The present study aimed to identify prognostic factors for patients with OSCC, especially the presence of DNA from human papillomavirus (HPV). Retrospective cohort study including 119 patients with OSCC treated at the National Cancer Institute in Mexico City (2009-2013). Clinical information was obtained from patient records including LR/DP. Formalin-fixed, paraffin-embedded tissues were obtained and used for detecting DNA from different types of HPV. Potential prognostic factors for Overall Survival (OS) were analyzed using the Cox proportional hazards model. After model adjustment, factors associated with longer OS were a pre-treatment platelet count above 400,000/mm3 (HR=0.09, p=0.026) and response to primary treatment (HR=0.26, p=0.001). HPV DNA was present in 23 (19.3%) of the patients and importantly, type 16 found in 19 of them. Although survival of HPV-positive patients was longer, difference was not significant. However, among patients with LR/DP, HPV positivity was significantly associated with increased survival (HR=0.23, p=0.034). Importantly, survival was significantly different for HPV-positive patients with LR/DP > 6 months (HR=0.20, p=0.002), had higher absolute lymphocyte count at start of treatment (HR=0.50, p=0.028) or had local rescue treatment (HR=0.24, p=0.019). Although HPV positivity was not associated with a longer OS of OSCC patients, a better prognosis was significantly associated with HPV positivity and recurring or progressing disease, particularly with HPV type 16.
- Intraoral onlay block bone grafts versus cortical tenting technique on alveolar ridge augmentations:a systematic review(2022) Aloy Prósper, Amparo; Carramolino-Cuéllar, Esther; Peñarrocha Oltra, David; Soto-Peñaloza, David; Peñarrocha Diago, MiguelTo review systematically the bone gain and superficial resorption rate of the onlay block bone grafts versus the cortical tenting technique, as well as secondarily study the postoperative complications, implant survival and success rates, and peri-implant marginal bone loss. Following the recommended methods for systematic reviews and meta-analyses (PRISMA), an electronic search was performed in the PubMed (MEDLINE), EMBASE and the Cochrane Library of the Cochrane Collaboration (CENTRAL) databases to identify all relevant articles published up to March 2021 on onlay block bone grafts and cortical tenting technique. Eighteen papers complied with the inclusion criteria. In onlay grafts, the vertical bone gain mean was 4.24 mm, and resorption 20.91%; and 4.29 mm in the horizontal augmentation with a resorption of 10.28%. The complication rate was 14.8%. The implant survival and success rates were 100% and 92%; and the mean peri-implant bone loss ranged from 0.6 to 1.26 mm. In cortical tenting technique, the vertical bone gain mean was 6.17 mm and the resorption of 9.99%; and 5.55 mm in the horizontal augmentation with a 6.12% of resorption. The complication rate was 24.6%. The implant survival and success rates were 96.63% and 100%; and the mean peri-implant bone loss ranged from 0.27 to 0.77mm. Despite the limitations, both techniques offer a predicTable way to reconstruct atrophic alveolar ridges, though the cortical tenting technique seems to achieve a greater bone gain and a lower surface resorption. Current evidence is still limited due to the inadequate follow-up, lack of information referred to methodological quality and sample attrition.
- Effects of a local single dose administration of growth hormone on the osseointegration of titanium implants(2022) Grossi, João Ricardo Almeida; Parra, Marcelo; Benalcázar-Jalkh, Ernesto B; Giovanini, Allan Fernando; Zielak, João Cézar; Sebstiani, Aline Monise; Gonzaga, Carla Castiglia; Coelho, Paulo G.; Witek, Lukasz; Deliberador, Tatiana MirandaThe aim of the present study was to evaluate the effect of different concentrations of growth hormone (GH) on endosteal implant?s surface at the early stages of osseointegration. Sixty tapered acid-etched titanium implants were divided into four groups: i) Collagen, used as a control group; and three experimental groups, where after collagen coating, GH was administered directly to the surface in varying concentrations: ii) 0.265 mg, iii) 0.53 mg, and iv) 1 mg. Implants were placed in an interpolated fashion in the anterior flange of C3, C4 or C5 of 15 sheep with minimum distance of 6 mm between implants. After 3-, 6- and 12-weeks of healing samples were harvested, histologically processed, qualitatively and quantitatively assessed for bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO). Statistical analysis as a function of time in vivo and coating resulted in no significant differences for BIC and BAFO at any evaluation time point. Histological evaluation demonstrated similar osseointegration features for all groups with woven bone formation at 3 weeks and progressive replacement of woven for lamellar bone in close contact with the implant surface and within the implant?s threads. A single local application of growth hormone to the surface of titanium implants did not yield improved implant osseointegration independent of healing time.
- HIV-related non-Hodgkin lymphomas affecting the oral cavity:a clinicopathologic study of 11 cases(2022) Uchôa, Daniel Cavalléro Colares; Corrêa Pontes, Flávia Sirotheau; de Souza, Lucas-Lacerda; dos Santos, Gabriela Sepêda; Ribeiro, Ana-Carolina-Prado; Brandao, Thais-Bianca; Rodrigues-Oliveira, Leticia; Gomes, Carolina Cavalieri; Santos Silva, Alan Roger; Fonseca, Felipe Paiva; Almeida, Oslei Paes de; Rebelo-Pontes, Hélder-AntônioHIV-related non-Hodgkin lymphomas of the oral cavity are rare lesions with aggressive clinical behaviour. The aim of this study is to describe the clinicopathological features of a series of HIV-related oral non-Hodgkin lymphomas. Eleven cases of oral lymphomas affecting HIV-positive patients were retrieved from 2012 to 2019. Clinicopathological features regarding age, sex, tumour location, clinical presentation, laboratory findings, disease stage and follow-up were obtained. Histologic, immunohistochemical and in situ hybridization for EBV detection were done for diagnosis confirmation. Overall survival was estimated by Kaplan?Meier curve. Males predominated, with a mean age of 40.3 years-old. Maxilla and mandible were the mostly affected. Plasmablastic lymphoma and diffuse large B-cell lymphoma not otherwise specified (NOS) were the main histological types. Lesions presented as reddish ulcerated swellings, representing the first sign of AIDS in six cases. Stage IV were common (7 cases) and the mean HIV viral load was 10,557 copies/mL, with a mean of 266 CD4+ cells/mm3, 1,278 CD8+ cells/mm3 and a CD4+/CD8+ ratio of 0.26. Eight patients died of the disease (72.7%). Overall survival revealed that 78.2% of the patients died after 21 months of follow-up. HIV-related oral lymphomas present a poor prognosis usually diagnosed in advanced stages and in our series plasmablastic lymphoma was the most common subtype.
- What is the accuracy of the surgical guide in the planning of orthognathic surgeries? A systematic review(2022) Goulart, Maria Eduarda Pereira; Biegelmeyer, Thaís Cargnino; Moreira-Souza, Larissa; Adami, Celso Ricardo; Deon, Fernando; Flores, Isadora Luana; Gamba, Thiago de OliveiraTo investigate the true accuracy of the surgical guide in the planning of orthognathic surgeries, which are performed worldwide. A systematic search was conducted in the PubMed database, Web of science, Scopus and Embase, covering August 2020 to January 2021. Studies that included patients with dentofacial deformity including anteroposterior, vertical and asymmetry problems who were undergoing an orthognathic surgery procedure were included; QUADAS-2 was used to determine the risk of bias by analyzing the quality of the studies. A PRISMA (flowchart) was created to show the study selection, keywords, nomination processes, and inclusion and exclusion criteria. Eleven studies were selected for qualitative and quantitative synthesis. All studies evaluated described high precision of the surgical guide, where the lowest error values were represented by the CAD/CAM technique. The planning and printing errors related to the guide were all less than 2 mm, and the absolute averages of the errors related to virtual planning in the analysis of the different plans were less than 1 mm. Finally, the measurement of the ANB angle obtained equivalent results between the virtual planning and the traditional.
