Adriano Rocha Germano

Block allograft for reconstruction of alveolar bone ridge in implantology: a systematic review.

Purpose: The aim of this study was to evaluate the literature regarding clinical efficacy and predictability of block allograft for restoration of vertical and/or horizontal bone defects. Materials and Methods: A literature search was conducted in PubMed/MEDLINE and Cochrane databases about studies reporting the use of block allografts. The review included studies published in English from 1960 to 2011 and excluded single-case reports and articles that did not use block allograft stabilized by fixation screws. Results: The search revealed 567 articles, but only 14 were included, which were conducted in humans with a total of 194 patients treated with block allografts, totalizing 253 blocks. Conclusions: Although a high success rate has been reported for the bone allograft survival, this systematic review demonstrated low level of scientific evidence articles with short follow-up time and diversified methodology with difficult possibilities to compare their results.

The influence of mandibular implant-retained overdentures in masticatory efficiency

OBJECTIVE To evaluate the masticatory efficiency of patients rehabilitated with conventional dentures (CDs) or implant-retained mandibular overdentures. BACKGROUND Despite the evident benefits of implants on mastication as assessed by subjective patient-based outcomes, the extent of implant overdenture treatment effect on food comminution is not well established. MATERIALS AND METHODS A randomised clinical trial was carried out with 29 completely edentulous patients divided into two groups. The first group was rehabilitated with a mandibular overdenture retained by two splinted implants with bar-clip system, while the second group was rehabilitated with a mandibular CD. Both groups also were rehabilitated with maxillary CDs. Masticatory efficiency and patient satisfaction were assessed 3 months after denture insertion. Masticatory efficiency was evaluated through the colorimetric method with the beads as the artificial test-food. Comparisons for masticatory efficiency and patient satisfaction were performed using Students t-test (α = 0.05). RESULTS No significant statistical difference was found for masticatory efficiency (p = 0.198). Patient overall satisfaction was significantly higher for the mandibular overdenture (p < 0.001). In addition, mandibular overdenture patients were significantly more satisfied with chewing experience (p < 0.05) and retention of the lower denture (p < 0.005). CONCLUSION The results of this study suggest that mandibular overdenture significantly improves chewing experience, although limited effect on masticatory efficiency has been observed.

Oral foreign body granuloma: unusual presentation of a rare adverse reaction to permanent injectable cosmetic filler

A variety of injectable permanent fillers have been used in orofacial tissues for cosmetic purposes. Most of these substances seem to be well tolerated but adverse reactions have been reported. Foreign body granulomas are a rare adverse reaction to injectable permanent fillers. The authors report the unusual case of a 56-year-old woman with a foreign body granuloma located exclusively in the oral cavity that was due to injection of a permanent filler.

Acute Primary Actinomycosis Involving the Hard Palate of a Diabetic Patient

Actinomycosis is a relatively rare infection caused by saprophytic bacteria of the oral cavity and gastrointestinal tract that can become pathogenic. The chronic hyperglycemia of diabetes mellitus induces events that promote structural changes in various tissues and are associated with problems in wound healing. This infection remains largely unknown to most clinicians because of its different presentations, and palatal involvement is extremely rare. This report describes the case of a 46-year-old woman who was diagnosed with actinomycosis involving the hard palate. The main clinical, histopathologic, and therapeutic characteristics and differential diagnosis of actinomycosis are reviewed. To date, 3 cases of actinomycosis involving the hard palate have been reported.

Treatment of mandibular glandular odontogenic cyst with immediate reconstruction: case report and 5-year follow-up

Glandular odontogenic cysts of the jaw are rare with unusual histopathological features, well-defined limits, and a high recurrence rate when treated conservatively. We describe a 37-year-old white man with such a cyst of the right mandible that was resected, and at follow-up 5 years later there were no signs of recurrence.

Distraction osteogenesis of iliac bone graft as a reconstruction after central giant cell granuloma curettage.

This case report describes a successful aesthetic and functional reconstruction of a patient who had severe maxilla bony deficiency as a result of excision of central giant cell granuloma. Initially, the lesion was curetted plus peripheral ostectomy. The defect was reconstructed with iliac bone graft in a second step, with both surgeries performed under general anesthesia. Six months after second step, later vertical distraction osteogenesis was performed on the grafted maxilla to obtain a satisfactory bony height. Distraction osteogenesis can be a good alternative for the reconstruction of bone deficiencies associated to bone graft; however, it should be not done as first treatment in the severe pathologic jaw defects.

Severe maxillofacial renal osteodystrophy in two patients with chronic kidney disease

Renal osteodystrophy (ROD) is the bone pathology that occurs as an uncommon complication related to the several alterations in mineral metabolism present in patients with chronic kidney disease (CKD). This paper describes two cases of severe ROD affecting the maxilla and mandible and causing facial disfigurement of a young and a middle-aged female patient with CKD. Both patients had a history of secondary hyperparathyroidism, previously treated by surgery. The pathogenesis of the disease, as well as its clinical, imaging, and histopathological features, and management of the patient are discussed.

Large solitary fibrous tumor of the oral cavity--report of a case.

The solitary fibrous tumor (SFT) is a rare soft tissue tumor with a substantially benign clinical behavior. The SFT of the oral cavity is a very uncommon entity. It is also of complicated diagnosis because of its extensive morphologic diversity and because of its similarity to many mesenchymal tumors. A 44-year-old man was referred for management of an asymptomatic lesion in the left buccal mucosa, which had been identified 10 years earlier. Intra-oral examination revealed a well-demarcated, fibroelastic, rounded exophytic mass located in the left buccal mucosa. The mass was covered with a non-ulcerated mucosa of normal color and measured approximately 4.0 cm in diameter. Histopathological examination showed proliferation of spindle-shaped cells arranged in fascicles and in a patternless pattern, highly vascularized, with focal staghorn vessels. Immunohistochemical analysis revealed diffuse positivity for CD34 and focal positivity for Bcl-2. Awareness of the morphological diversity of SFT coupled to a judicious use of appropriate immunohistochemical probes should prove valuable to accurately segregate SFT from other spindle cell neoplasms.

Infected orthokeratinized odontogenic cyst: a rare cause of facial cellulitis

Orthokeratinized odontogenic cysts (OOCs) are relatively uncommon developmental cysts lined with orthokeratinized epithelium consisting of a prominent granular layer and a basal layer of low cuboidal flattened cells that show no tendency for nuclear palisading. These cysts have been considered a distinct entity from odontogenic keratocysts since they exhibit a less aggressive behavior and a very low rate of recurrence. Developmental odontogenic cysts can become infected but serious complications, such as potentially life-threatening cellulitis, are rare. This report describes a rare case of facial cellulitis secondary to an infected OOC located in the mandible of a 27-year-old man. The relevant literature about the clinical-pathological features of OOC is reviewed.

Impact of mandibular conventional denture and overdenture on quality of life and masticatory efficiency.

The aim of this non-randomized controlled clinical trial was to evaluate the oral health-related quality of life and masticatory efficiency of patients rehabilitated with mandibular two-implant overdentures with immediate loading or conventional dentures. Fifty completely edentulous patients wearing bimaxillary conventional dentures, for at least one year, were recruited. The patients were then assigned to either two treatment groups: mandibular overdentures supported by two implants with bar-clip system and a maxillary conventional denture (n = 25), and new maxillary and mandibular conventional complete dentures (n = 25). Masticatory efficiency and oral health-related quality of life were assessed before and 3 months after denture insertion. The Brazilian version of OHIP-Edent questionnaire was used to assess the oral health-related quality of life. Masticatory efficiency was evaluated with chewing capsules through a colorimetric method. The results revealed fewer oral health-related quality of life problems in patients wearing mandibular two-implant overdentures compared to the conventional dentures group. In addition, the implant overdenture group presented statistically significant improvement in masticatory efficiency (p = 0.001). There was no correlation between masticatory efficiency and OHIP in the implant group (p > 0.05), however a correlation was found in the conventional denture group (p < 0.05). Therefore, these short-term results suggest that mandibular overdenture retained by 2 implants with immediate loading combined with maxillary conventional dentures provide better masticatory efficiency and oral health-related quality of life than mandibular conventional dentures.