Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2012. Vol. 17, no. 5

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    Sensibility and taste alterations after impacted lower third molar extractions. A prospective cohort study
    (2012) Ridaura Ruíz, Lourdes; Figueiredo, Rui; Valmaseda Castellón, E.; Berini Aytés, Leonardo; Gay Escoda, Cosme
    Objectives: To determine the incidence, severity and duration of lingual tactile and gustatory function impairments after lower third molar removal. Study Design: Prospective cohort study with intra-subject measures of 16 patients undergoing lower third molar extractions. Sensibility and gustatory functions were evaluated in each subject preoperatively, one week and one month after the extraction, using Semmes-Weinstein monofilaments and 5 different concentrations of NaCl, respectively. Additionally, all patients filled a questionnaire to assess subjective perceptions. Results: Although patients did not perceive any sensibility impairments, a statistically significant decrease was detected when Semmes-Weinstein monofilaments. This alteration was present at one week after the surgical procedure and fully recovered one month after the extraction. There were no variations regarding the gustatory function. Conclusions: Lower third molar removal under local anesthesia may cause light lingual sensibility impairment. Most of these alterations remain undetected to patients. These lingual nerve injuries are present one week after the extraction and recover one month after surgery. The taste seems to remain unaffected after these procedures
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    Guided implant surgery with modification of the technique involving the raising of a semicircular miniflap : a preliminary study. Review
    (2012) Peñarrocha Diago, María; Viña Almunia, José; Maestre Ferrín, Laura; Peñarrocha Oltra, David; Balaguer Martínez, José
    Objective: An evaluation is made of pain, swelling and peri-implant attached mucosal width after implant-based rehabilitation involving guided surgery and a modification of the technique with the raising of a semicircular miniflap, in single and partial replacements. Study design: A case-control study was carried out. The study group consisted of 12 patients with the placement of 19 implants using a guided surgery and miniflap technique. The control group consisted of 12 patients with the placement of 22 implants using the conventional technique. Each patient scored postoperative swelling and pain by means of a visual analog scale (VAS). Attached vestibular mucosa width was evaluated 12 weeks after implant placement. Results: Twelve operations were carried out in each group. Immediate aesthetics were established for all implants of the study group. One implant failed in each group. Maximum pain was recorded after 6 hours in both groups (mean VAS score 4 and 4.9 in the study and control group, respectively). Maximum swelling was recorded after 24 hours (mean VAS score 2.5) in the study group and on the second day (mean VAS score 3.4) in the control group. The mean attached vestibular mucosa width was 2.9 mm in the study group and 3.2 mm in the control group. Conclusion: In this preliminary study, guided implant surgery with a semicircular miniflap in single and partial replacements resulted in slightly less postoperative pain and swelling than with the conventional implant technique. The attached vestibular mucosa width was greater in the control group, though the differences were very small.
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    Evaluation of the validity of the Bolton Index using cone-beam computed tomography (CBCT)
    (2012) Tarazona Álvarez, Beatriz; Llamas Carreras, José María; Cibrián Ortiz de Anda, Rosa María; Gandía Franco, José Luis; Paredes Gallardo, Vanessa
    Aims: To evaluate the reliability and reproducibility of calculating the Bolton Index using cone-beam computed tomography (CBCT), and to compare this with measurements obtained using the 2D Digital Method. Material and Methods: Traditional study models were obtained from 50 patients, which were then digitized in order to be able to measure them using the Digital Method. Likewise, CBCTs of those same patients were undertaken using the Dental Picasso Master 3D® and the images obtained were then analysed using the InVivoDental programme. Results: By determining the regression lines for both measurement methods, as well as the difference between both of their values, the two methods are shown to be comparable, despite the fact that the measurements analysed presented statistically significant differences. Conclusions: The three-dimensional models obtained from the CBCT are as accurate and reproducible as the digital models obtained from the plaster study casts for calculating the Bolton Index. The differences existing between both methods were clinically acceptable
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    Job satisfaction and depression in the Spanish Society of Periodontology and Research (SEPA) members, and their relation to the burnout syndrome. Creation of a structural model
    (2012) Reyes Torres, Mercedes; Ríos Santos, José Vicente; López Jiménez, Ana María; Herrero Climent, Mariano; Bullón, Pedro
    Objective: This study is aimed at getting to know the existing relationship between the dimensions of the burnout syndrome and job satisfaction, on one hand, and depressive feelings on the other through the creation of a structural model aimed at relating all these concepts on a sample of Spanish periodontists. Study design: The initial sample comprised 284 individuals, who represented 20% of the members of the Spanish Society of Periodontology and Research (www.SEPA.es). These individuals were chosen randomly by means of stratified sampling with proportional affixation by their autonomous community of residence. All participants were sent by post the MBI, CET and job-satisfaction questionnaires. The software package used for data analysis was LISREL v. 8.7 by checking models of structural equations so as to prove the proposed model?s adjustment. Results: The total number of answered questionnaires was 170 (59.85%). A positive relation was observed between emotional tiredness and depersonalization and depression. However, this dimension correlated negatively with job satisfaction and self-realization. Conclusions: The obtained results show that, in this sample of periodontists, job satisfaction acts as a modulator in the transition from emotional tiredness to depression
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    Morphology and dimensions of the dentogingival unit in the altered passive eruption
    (2012) Alpiste Illueca, Francisco M.
    Objetives: This study define altered passive eruption (APE) and evaluate the morphology of the dentogingival unit. Material and Methods: 123 individuals subjected to clinical examination and parallel profile radiography of the upper central incisor. An evaluation was made of the correlation between the clinical diagnosis of APE and the degree of gingival overlap; by using a 19% overlap to define APE (Kappa concordance index = 0.7). The Mann- Whitney / Wilcoxon test was used to identify the variables influencing APE. Results: Statistically significant differences were observed between the teeth with and without APE: gingival width (p = 0.0073), clinical crown length (p = 0.0000), smiling exposed gums (p = 0.0000), bone crest thickness (p = 0.0030), connective tissue attachment thickness (p = 0.0003) and biological width (p = 0.0015). Conclusions: The APE is characterized by: a gingival overlapping of over 19% of the length of the anatomical crown, increased gingival width and gingival smile; furthermore is associated to a thick bone crest and connective tissue attachment. Statistical analysis confirms two morphological patterns of APE.
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    Resonance frequency analysis-reliability in third generation instruments : Osstell mentor ®
    (2012) Herrero Climent, Mariano; Albertini, Matteo; Ríos Santos, José Vicente; Lázaro Calvo, Pedro; Fernández Palacín, Ana; Bullón, Pedro
    Few studies assess repeatability and reproducibility in registers of resonance frequency analysis (a value of dental implant stability). Objective: Few studies assess repeatability and reproducibility in resonance frequency analyses (implant stability evaluation). This study is aimed at assessing reliability (repeatabilty and reproducibility) in the Osstell Mentor® system using the intraclass correlation coefficient (ICC) as the statistical method. Study Design: ISQ measurements of RFA were carried out by means of the Osstell Mentor ® instrument in 58 implants in 19 patients. Six measurements were performed on each implant by means of two different Smart-Pegs (I and II). Three consecutive measurements were registered with each transducer. Results: Average ISQ varied from 72.43 to 72.60 and 73.26 in the first, second and third measurements, respectively with the SamrtPeg I and from 72.98 to 73.26 and 73.74 in the first, second and third measurements, respectively with the SamrtPeg II . Exactly equal values were observed in 10.43 and 12.1% of the cases with Smart-Pegs I and II, respectively. The intraclass correlation coefficient was 0.96 and 0.96 for Smart Pegs I and II, respectively. Repeatability and reproducibility was 0.97 for both Smart-Pegs I and II. Conclusions: The RFA system contributed by Osstell Mentor ® renders almost perfect reproducibility and repeatability, as proven by statistical analysis carried out by means of ICC with 95% confidence level. This instrument contributes highly reliable RFA measurements in dental implants.
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    Gingival recession and associated factors in a homogeneous Mexican adult male population : a cross-sectional study
    (2012) Minaya Sánchez, Mirna; Medina Solís, Carlo Eduardo; Vallejos Sánchez, Ana Alicia; Márquez Corona, María de Lourdes; Pontigo Loyola, América Patricia; Islas Granillo, Horacio; Maupomé, Gerardo
    Background: Diverse variables are implicated in the pathogenesis of gingival recession; more detailed knowledge about the relationship between the clinical presentation of gingival recession and assorted risk indicators may lead to improved patient monitoring, early intervention, and subsequent prevention. The objective was to evaluate clinically gingival recession in a homogeneous Mexican adult male population and to determine the strength of association with related factors. Method: A cross-sectional study was carried out in a largely homogeneous group in terms of ethnic background, socioeconomic status, gender, occupation, and medical/dental insurance, in Campeche, Mexico. Periodontal examinations were undertaken to determine diverse clinical dental variables. All periodontal clinical examinations were assessed using the Florida Probe System, a dental chair and one examiner. Questionnaires were used to collect diverse risk indicators. Statistical analyses were undertaken with negative binomial regression models. Results: The mean number of sites with gingival recession per subject was 6.73±5.81; the prevalence was 87.6%. In the negative binomial regression model we observed that for (i) each year of age, and (ii) each percentage unit of increase in sites with plaque, and (iii) with suppuration, mean sites with gingival recession increased 2.9%, 1.0% and 13.0%, respectively. Having a spouse was associated with gingival recession. Conclusions: We observed association between gingival recession, and sociodemographic and clinical parameters. Patients need to be educated about risk indicators for gingival recession as well as the preventive maneuvers that may be implemented to minimize its occurrence. The potential of improved oral self-care to prevent a largely benign condition such as gingival recession is important, given the associated disorders that may ensue root exposure, such as root caries and root hypersensitivity.
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    Accidental displacement and migration of endosseous implants into adjacent craniofacial structures : a review and update
    (2012) González García, Alberto; González García, J.; Diniz Freitas, Márcio; García García, Abel; Bullón, Pedro
    Objectives: Accidental displacement of endosseous implants into the maxillary sinus is an unusual but potential complication in implantology procedures due to the special features of the posterior aspect of the maxillary bone; there is also a possibility of migration throughout the upper paranasal sinuses and adjacent structures. The aim of this paper is to review the published literature about accidental displacement and migration of dental implants into the maxillary sinus and other adjacent structures. Study D esign: A review has been done based on a search in the main on-line medical databases looking for papers about migration of dental implants published in major oral surgery, periodontal, dental implant and ear-nose- throat journals, using the keywords ?implant,? ?migration,? ?complication,? ?foreign body? and ?sinus.? Results: 24 articles showing displacement or migration to maxillary, ethmoid and sphenoid sinuses, orbit and cranial fossae, with different degrees of associated symptoms, were identified. Techniques found to solve these clinical issues include Cadwell-Luc approach, transoral endoscopy approach via canine fossae and transnasal functional endoscopy surgery. Conclusion: Before removing the foreign body, a correct diagnosis should be done in order to evaluate the functional status of the ostiomeatal complex and the degree of affectation of paranasal sinuses and other involved structures, determining the size and the exact location of the foreign body. After a complete diagnosis, an indicated procedure for every case would be decided
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    Antiepileptic drugs for the treatment of neuropathic pain : a systematic review
    (2012) Vargas Espinosa, M.L.; Sanmartí García, Gemma; Vázquez Delgado, Eduardo; Gay Escoda, Cosme
    Many therapies have been proposed for the management of neuropathic pain, and they include the use of different antiepileptic drugs. However, the lack of high quality studies indicates that results on the different neuropathic disorders under study do not recommend a particular drug treatment. This study makes a systematic review of the published literature on the use of several antiepileptic drugs to treat neuropathic pain, and has the objective of considering both its clinical characteristics and pharmacological use, which will depend on their level of scientific evidence and will follow the principles of evidence-based dentistry. The articles were stratified according to their scientific evidence using the SORT criteria (Strength of Recommendation Taxonomy), and it included those articles that only have level 1 or 2. Randomized clinical trials were stratified according to their level of quality using the JADAD scale, an instrument described by Jadad et al . (7) . to assess the quality of clinical trials, while studies with a level below 3 were discarded. Recently, type A or B recommendations are given in favor or against the use of antiepileptic drugs to treat neuropathic pain on the basis of their scientific quality.
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    Temporomandibular disorders : a case-control study
    (2012) Poveda Roda, Rafael; Bagán Sebastián, José Vicente; Sanchís Bielsa, José María; Carbonell Pastor, Enrique
    Objective: To compare the risk factors and clinical manifestations of patients with temporomandibular disorders (TMDs) diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) (axis I) versus an age and gender matched control group. Study D esign: A total of 162 patients explored according to the RDC/TMD (mean age 40.6±18.8 years, range 7-90; 11.1% males and 88.9% females) were compared with 119 controls, measuring differences in TMD risk factors (sleep disturbances, stress, psychoactive medication, parafunctions, loss of posterior support, ligament hyperlaxity) and clinical variables (joint sounds, painful muscle and joint palpation, maximum aperture). Results: Myofascial pain (MFP) (single or multiple diagnoses) was the most frequent diagnosis (42%). The most common diagnostic combination was MFP plus arthralgia (16.0%). Statistically significant differences were observed in clenching (OR 2.3; 95%CI: 1.4-3.8) and in maximum active aperture (MAA) on comparing the two groups both globally (TMD vs. controls) (patients 36.7±8.6 mm, controls 43.1±5.8 mm; F=45.41, p = 0.000) and on comparing according to diagnostic categories. MFP explained most of the observed differences in the risk factors: stress perception (OR=1.98;I.C.:1.01-3.89), psychoactive medication (OR=2.21; I.C.:1.12-4.37), parafunctions (OR=2.14;I.C.:1.12-4.11), and ligament laxity (OR=2.6;I.C.:1.01-6.68). Joint sounds were more frequent in patients with MFP (39.7% vs. 24.0%; ?2=4.66; p=0.03), and painful joint palpation was more common in patients with disc displacement with reduction (DDWR)(15.9% vs. 5.0%; ?2 = 5.2; p = 0.02) and osteoarthrosis (20.8% vs. 5.0%; ?2 = 7.0; p = 0.008). Conclusions: There is a high prevalence of signs and symptoms of TMDs in the general population. Significant differences are observed in clenching and MAA between patients and controls considered both globally and for each diagnostic category individually. The analyzed risk factors (except loss of posterior support) show a statistically significant OR for the diagnosis of MFP.
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    Treatment of temporomandibular myofascial pain with deep dry needling
    (2012) González Pérez, Luis Miguel; Infante Cossío, Pedro; Granados Nuñez, Mercedes; Urresti López, Francisco Javier
    Objectives: The present study was designed to evaluate the usefulness of deep dry needling in the treatment of temporomandibular myofascial pain. Study D esign: We selected 36 patients with myofascial pain located in the external pterygoid muscle (30 women/6 men, mean age=27 years with SD±6,5). We studied differences in pain with a visual analog scale and range of mandibular movements before and after intervention. Results: We found a statistically significant relationship (p<0,01) between therapeutic intervention and the improvement of pain and jaw movements, which continued up to 6 months after treatment. Pain reduction was greater the higher was the intensity of pain at baseline. Conclusions: Although further studies are needed, our findings suggest that deep dry needling in the trigger point in the external pterygoid muscle can be effective in the management of patients with myofascial pain located in that muscle.
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    Survival of implants placed with the osteotome technique : an update. Review
    (2012) Viña Almunia, José; Maestre Ferrín, Laura; Alegre Domingo, Teresa; Peñarrocha Diago, María
    A literature review is made to analyze the survival of implants placed with the osteotome technique. A PubMed search was made based on the key words ?osteotome AND dental implants?, corresponding to publications between 1998-2008. Th e inclusion criteria were: a) a minimum of 10 patients; b) a minimum follow-up of 6 months; c) implants placed using the osteotome technique with or without indirect sinus lift; and d) specification of the implant number and survival rate. Sixty-four articles were identified, of which 20 met the inclusion criteria. A total of 2006 implants were placed in 1312 patients using the osteotome technique. Th e duration of follow-up after prosthetic loading ranged from 6-144 months. Indirect sinus lift was carried out in all but one of the studies. Th e residual crest height ranged from 2.3-11.7 mm. with a mean gain in bone after sinus lift of 2.5-5.5 mm. Th e time from implant placement to prosthetic loading varied from 1.5-9 months. Th e percentage implant survival rate was 90.5-100%. Th e survival rate of implants placed with the osteotome technique is high and does not differ with respect to implant placement with the conventional technique
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    Influence of root canal instrumentation and obturation techniques on intra-operative pain during endodontic therapy
    (2012) Martín González, Jenifer; Echevarría Pérez, Marta; Sánchez Domínguez, Benito; Tarilonte Delgado, María Luisa; Castellanos Cosano, Lizett; López Frias, Javier; Segura-Egea, Juan J.
    Objective: To analyse the influence of root canal instrumentation and obturation techniques on intra-operative pain experienced by patients during endodontic therapy. Method and Materials: A descriptive cross-sectional study was carried out in Ponferrada and Sevilla, Spain, including 80 patients (46 men and 34 women), with ages ranged from 10 to 74 years, randomly recruited. Patient gender and age, affected tooth, pulpal diagnosis, periapical status, previous NSAID or antibiotic (AB) treatment, and root canal instrumentation and obturation techniques were recorded. After root canal treatment (RCT), patients completed a 10-cm visual analogue scale (VAS) that ranked the level of pain. Results were analysed statistically using the Chi-square and ANOVA tests and logistic regression analysis. Results: The mean pain level during root canal treatment was 2.9 ± 3.0 (median = 2) in a VAS between 0 and 10. Forty percent of patients experienced no pain. Gender, age, arch, previous NSAIDs or AB treatment and anaesthetic type did not influence significantly the pain level (p > 0.05). Pain during root canal treatment was significantly greater in molar teeth (OR = 10.1; 95% C.I. = 1.6 - 63.5; p = 0.013). Root canal instrumentation and obturation techniques did not affect significantly patient?s pain during root canal treatment (p > 0.05). Conclusion: Patients feel more pain when RCT is carried out on molar teeth. The root canal instrumentation and obturation techniques do not affect significantly the patients? pain during RCT.
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    Immunohistochemical expression of EGFR in oral leukoplakia : association with clinicopathological features and cellular proliferation
    (2012) Ribeiro, Daniela Cotta; Gleber Netto, Frederico Omar; Sousa, Sílvia Ferreira; Bernar des, Vanessa de Fátima; Guimaraes Abreu, Mauro Henrique Nogueira; Aguiar, Maria Cássia Ferreira
    Objectives: to investigate the immunoexpression of epidermal growth factor receptor (EGFR) in a sample of oral leukoplakias (OL) and to determine the receptor?s association with dysplasia, tobacco consumption, lesion site, and proliferation rate. Although EGFR should be overexpressed in some oral leukoplakias, the factors that may interfere with this expression and the influence of this receptor on epithelial proliferation have yet to be investigated. Study Design: Samples of oral leukoplakias (48) and of normal oral epithelium (10) were immunohistologically examined for expression of EGFR. Immunohistochemistry for Ki-67, and p27 were also performed in leukoplakias. EGFR expression was associated with clinical and pathological features. Results: EGFR was positive in 62.5% of the leukoplakias and 50% of normal oral epithelium. The number of EGFR positive OL located in high-risk sites was significantly higher than EGFR positive OL located in low-risk sites. Most of the p27 negative leukoplakias were EGFR positive, and the p27 index in the parabasal layer was diminished in the presence of dysplasia. Positivity for EGFR was not associated with dysplasia, tobacco exposure, or Ki-67. Conclusion: EGFR is expressed in leukoplakia regardless of dysplasia, but EGFR positivity should be more frequent in lesions sited in areas of high cancer risk. The association between EGFR and p27 may represent an important mechanism in the control of cellular proliferation and malignant progression of oral epithelium and therefore warrants further investigation.
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    Oro-facial manifestations of 100 leprosy patients
    (2012) Taheri, Jamileh Bigom; Mortazavi, Hamed; Moshfeghi, Mahkameh; Bakhshi, Mahin; Bakhtiari, Sedigheh; Azari Marhabi, Saranaz; Alirezaei, Somayeh
    Objectives: To verify the frequency of oral and facial involvement in diagnosed leprosy patients. Study design: This study was performed on 100 leprosy patients (62 male, 38 female, mean ages 51.86±6.1). After explaining the study design, we studied descriptive information including: patient?s sex, age, job, place of birth, familial history of leprosy, types of disease (lepromatous, borderline and tuberculoid leprosy), ocular and oral lesions, facial involvement and neuropathy. The statistical signification was measured by chi-square test. Results: A total of 46 (23 lepromatous, 15 borderline, and 8 tuberculoid leproy) out of 100 patients with leprosy had oral lesions. Statistical analysis did not show any significant difference in frequency of oral lesions between different types of disease. Facial lesions were presented in 57 (39 lepromatous, 10 borderline, and 8 tuberculoid leprosy) patients. There was a statistical significant difference in frequency of facial manifestations between different types of leprosy. It has to be mentioned that, atrophy of nasal spine, facial nerve involvement, ocular lesions and facial deformity were seen in 15%, 17%, 22% and 44% of leprosy patients, respectively. Conclusion: Examination of leprosy patients should be extended to the oral mucosa because oral mucosa may be a secondary source of M.Leprae transmission and infection
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    Osseous reaction to implantation of two endodontic cements : mineral trioxide aggregate (MTA) and calcium enriched mixture (CEM)
    (2012) Rahimi, Saeed; Mokhtari, Hadi; Shahi, Shahriar; Kazemi, Ali; Asgary, Saeed; Eghbal, Mohammad Jafar; Mesgariabbasi, Mehran; Mohajeri, Daryoush
    Aim: The aim of the present in vivo study was to determine bone tissue reaction to calcium enriched mixture (CEM) and mineral trioxide aggregate (MTA) using a rat femur model. Study Design: Sixty-three rats were selected and randomly divided into three groups of 21 each [experimental groups (n=15), control (n=6)]. Implantation cavities were prepared in each femoral bone and randomly filled with the biomaterials only in the experimental groups. The animals in three groups were sacrificed 1, 4, and 8 weeks postoperatively. Histologic evaluations comprising inflammation severity and new bone formation were blindly made on HE-stained decalcified 6-?m sections. Results: At 1, 4, and 8 weeks after implantation number of inflammatory cells had decreased in the CEM, MTA and control groups, respectively, with no statistically significant differences. Conversely, new bone formation had increased in all the experimental and control groups, without statistically significant differences. Conclusion: The results suggest that biocompatibility of MTA, as gold standard, and CEM cement as a new endodontic biomaterial are comparable
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    P53 and bcl-2 immunoexpression in patients with oral lichen planus a nd oral squamous cell carcinoma
    (2012) Leyva Huerta, Elba Rosa; Ledesma Montes, Constantino; Rojo Botello, Rebeca Estela; Vega Memije, María Elisa
    Objective : The aim of this study was to determine by immunohistochemistry the presence and significance of p53 and bcl-2 proteins in oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC). Study D esign : We used 21 cases diagnosed as OLP 16 diagnosed as OSCC and four normal gingival biopsies taken from healthy patients were used as controls. Slides were processed for immunohistochemistry using anti-p53 and anti-bcl-2 monoclonal antibodies. Results : We found p53 immunoexpression in 71.4 % OLP cases and 68.7 % OSCC cases, with no immunoexpression in control cases. Bcl-2 was negative for all OLP and OSCC cases, and mild positivity was observed in normal tissue. We found significant correlation among p53 expression and OSCC malignancy. Conclusions : Our results suggest that TP53 system mainly promotes a hyperproliferative state by cell cycle arrest of the OLP epithelial cells for repairing damaged DNA nor apoptosis and that anti-apoptotic action of bcl-2 is not important in this disease.
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    Oral bisphosphonate-related osteonecrosis of the jaws : clinical characteristics of a series of 20 cases in Spain
    (2012) Diniz Freitas, Márcio; López-Cedrún Cembranos, José Luis; Fernández Sanromán, J.; García García, Abel; Fernández Feijoo, Javier; Diz Dios, Pedro
    Objective: The objective of this study was to define the clinical characteristics of osteonecrosis of the jaws (ONJ) induced by oral bisphosphonates in a series of patients from a circumscribed area in northwest Spain. Study Design: A retrospective multicentre study was undertaken in 3 hospitals in an area with a radius less than 100 km in the Autonomous Community of Galicia (Spain). The medical records were reviewed and an oral examination was performed of patients diagnosed with oral bisphosphonate-related ONJ in the previous 3 years. Results: We detected 20 cases of ONJ (24 lesions) related to oral bisphosphonates (alendronate [16 patients] and ibandronate [4 patients]), which were mainly administered as treatment for osteoporosis (17 patients). The mean interval between initiation of treatment and confirmation of a diagnosis of ONJ was 66±43 months (range, 6-132 months); in 7 patients (35%) the interval was less than 36 months. The past history revealed hypertension in 13 cases (65%) and diabetes in 4 (20%); 7 patients (35%) were on corticosteroid treatment. Oral surgery had been previously performed in 13 patients (65%) and the remaining 7 patients (35%) had removable dental prostheses. The lesions most frequently affected the posterior mandible (62.5%). The majority of the lesions (75%) were classified as stage 2, although lesions were identified in all established clinical stages (including 2 stage 0 lesions). Conclusion: In conclusion, in the present series, ONJ induced by oral bisphosphonates typically develops in women around 70 years of age, taking alendronate, that underwent oral surgery. Most lesions are located in the posterior mandible and are classified as stage 2 at diagnosis. Some patients presented no known risk factors, suggesting that there may be risk factors still to be identified. There are well-defined patterns of clinical presentation that can facilitate early diagnosis of ONJ.
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    Stromal myofibroblasts in oral leukoplakia and oral squamous cell carcinoma
    (2012) Assis, Eliene Magda de; Pimenta, Luiz Gustavo Garcia Santos; Costa e Silva, Edson; Souza, Paulo Eduardo Alencar; Horta, Martinho Campolina Rebello
    Objectives: Oral leukoplakia (OL) is the main potentially malignant disorder and oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral mucosa. Stromal myofibroblasts play an important role in tumor invasion and metastasis, due to its ability to modify the extracellular matrix. This study aimed to evaluate the presence of stromal myofibroblasts in OL and OSCC. Differences in the presence of myofibroblasts among OL with distinct grades of epithelial dysplasia as well as between histologically high- and low-invasive OSCC were also assessed. Study D esign: A total of 30 OL and 41 OSCC from archival formalin-fixed, paraffin-embedded specimens were evaluated. 10 samples of normal oral mucosa were used as a control. Myofibroblasts were identified by immunohistochemical detection of alpha smooth muscle actin and its presence was classified as negative, scanty or abundant. Differences in the presence of myofibroblasts among OL with distinct grades of epithelial dysplasia as well as between high- and low-invasive OSCC were analyzed using the Mann-Whitney test. Results: Myofibroblasts were not detected in normal oral mucosa and OL, whatever its histological grade. In OSCC, the presence of stromal myofibroblasts was classified as negative in 11 (26.8%), scanty in 15 (36.6%), and abundant in 15 samples (36.6%). The presence of stromal myofibroblasts was statistically higher in high-invasive OSCC than in low-invasive OSCC (p<0.05). Conclusions: Stromal myofibroblasts were not detected in OL, indicating that these cells are not important during oral carcinogenesis. Nevertheless, stromal myofibroblasts were heterogeneously detected in OSCC and its presence was higher in tumors with a more diffuse histological pattern of invasion. These findings suggest that myofibroblasts are associated with the creation of a permissive environment for tumor invasion in OSCC
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    Microhardness of different resin cement shades inside the root canal
    (2012) Vignolo, Valeria; Fuentes Fuentes, María Victoria; Garrido, Miguel Angel; Rodríguez, Jesús; Ceballos García, Laura
    Objectives: To compare microhardness along the root canal post space of two resin cements in different shades and a dual-cure resin core material. Study D esign: Root canals of 21 bovine incisors were prepared for post space. Translucent posts (X?Post, Dentsply DeTrey) were luted using one the following resin luting agent: Calibra (Dentsply DeTrey) in Translucent, Medium and Opaque shades, RelyX Unicem (3M ESPE) in Translucent, A2 and A3 shades and the dual-cure resin core material Core?X flow. All materials were applied according to manufacturers? instructions and were all photopolymerized (Bluephase LED unit, Ivoclar Vivadent, 40s). After 24 hours, roots were transversally cut into 9 slices 1 mm thick from the coronal to apical extremes, three corresponding to each root third. Then, VHNs were recorded (100gf, 30 s) on the resin luting materials along the adhesive interface in all sections. Data were analyzed by two- way ANOVA and SNK tests (?=0.05). Results: A significant influence on microhardness of resin luting material in their respective shades (p<0.001), root third (p<0.001) and interactions between them was detected (p<0.001). RelyX Unicem cement showed the highest microhardness values and Calibra the lowest, regardless of the shade selected. All resin luting materials tested exhibited a significantly higher microhardness in the cervical third. Conclusions: Microhardness of resin luting agents tested inside the canal is dependent on material brand and resin cement shade seems to be a less relevant factor. Microhardness decreased along the root canal, regardless of the shade selected