Luciano Lauria Dib

Management of chemo- and radiotherapy induced oral mucositis with low-energy laser: initial results of A.C. Camargo Hospital

Background. Oral mucositis is a common complication of some malignancies treatment, causing therapeutic modifications due to patients debilitation, which often interferes with the prognosis of the disease. Many attempts have been made to find an optimal treatment or preventive method to minimize the severity of oral mucositis. Several studies have shown good results with the use of low-energy laser, with the aim of accelerating the process of wound healing and promoting pain relief. Methods. Patients (n=18) who developed oral mucositis during chemotherapy and/or radiotherapy were submitted to low-energy laser applications until cessation of symptoms. Mucositis severity was scored by an oral mucositis scale based on clinical features and by an oral toxicity scale from the National Cancer Institute based on the ability to swallow; pain severity was scored by subjects on a visual analogue scale before and after the applications. Results. Immediate pain relief was achieved in 66.6% of the patients after the first application. Based on the functional scale, mucositis grade III (not capable to eat solids) was reduced in 42.85% of the cases. According to the scale based on the clinical features, mucositis grade IV (ulcerative lesions) was reduced in 75% of the patients that presented this grade of mucositis at the beginning of laser therapy. Conclusions. Low-energy laser was well-tolerated and showed beneficial effects on the management of oral mucositis, improving the quality of life during the oncologic treatment.

Platelet-rich plasma in bone repair of irradiated tibiae of Wistar rats

PURPOSE To evaluate the influence of PRP addition on bone repair of circular defects created in irradiated tibiae of rats by histometric analysis. METHODS Sixty male Wistar rats had the right tibiae irradiated with 30 Gy. After 30 days monocortical defects were created and platelet-rich plasma was applied in 30 rats. In the control group defects were created but not filled. The animals were desanguinated after 4, 7, 14, 21, 56 and 84 days and the tibiae removed for histological processing. RESULTS There was a tendency in the PRP group to increased bone neoformation from 14-days to 84-days; in the control group increased bone neoformation was not seen after 21 days or later. CONCLUSION The addition of platelet-rich plasma had a beneficial effect in the initial cellular regeneration period and enhanced bone formation in later periods when compared to control.

Bone-anchored titanium implants for auricular rehabilitation: case report and review of literature

CONTEXT AND OBJECTIVE Osseointegrated implants have acquired an important role in the prosthetic rehabilitation of patients with craniofacial defects. The main indications are lack of local tissue for autogenous reconstruction, previous reconstruction failure and selection of this technique by the patient. This paper presents a clinical case and discusses indications and advantages of the osseointegrated implant technique for retention of auricular prostheses. TYPE OF STUDY Case report, Universidade Federal de São Paulo (UNIFESP). METHODS A female patient received three auricular implants after surgical resection of a hemangioma in her left ear. The time taken for osseointegration of the temporal bone was three months. After fabrication of the implant-retained auricular prosthesis, the patient was monitored for 12 months. RESULTS The clinical parameters evaluated showed good postoperative healing, healthy peri-implant tissue, good hygiene and no loss of implants. Good hygiene combined with thin and immobile peri-implant soft tissues resulted in minimal complications. Craniofacial implant integration appears to be site-dependent; increasing age affects osseointegration in the temporal bone. The frequency of adverse skin reactions in peri-implant tissues is generally low. CONCLUSION The surgical technique for rehabilitation using implant-retained auricular prostheses seems to be simple. It is associated with low rates of adverse skin reactions and long-term complications. Prostheses anchored by osseointegrated implants seem to provide better retention than do prostheses supported on spectacle frames, less risk of discoloration through the use of adhesives and better esthetic results than do prostheses anchored in the surgical cavity.

Monoscopic photogrammetry to obtain 3D models by a mobile device: a method for making facial prostheses

PurposeThe aim of this study is to present the development of a new technique to obtain 3D models using photogrammetry by a mobile device and free software, as a method for making digital facial impressions of patients with maxillofacial defects for the final purpose of 3D printing of facial prostheses.MethodsWith the use of a mobile device, free software and a photo capture protocol, 2D captures of the anatomy of a patient with a facial defect were transformed into a 3D model. The resultant digital models were evaluated for visual and technical integrity. The technical process and resultant models were described and analyzed for technical and clinical usability.ResultsGenerating 3D models to make digital face impressions was possible by the use of photogrammetry with photos taken by a mobile device. The facial anatomy of the patient was reproduced by a *.3dp and a *.stl file with no major irregularities. 3D printing was possible.ConclusionsAn alternative method for capturing facial anatomy is possible using a mobile device for the purpose of obtaining and designing 3D models for facial rehabilitation. Further studies must be realized to compare 3D modeling among different techniques and systems.Clinical implicationFree software and low cost equipment could be a feasible solution to obtain 3D models for making digital face impressions for maxillofacial prostheses, improving access for clinical centers that do not have high cost technology considered as a prior acquisition.

Orbit Rehabilitation with Extraoral Implants: Impact of Radiotherapy

PURPOSE The aim of the study was to compare the success rates of osseointegration among irradiated and nonirradiated cases submitted to implant placement for anchorage of orbit prostheses from 2003 to 2011. MATERIALS AND METHODS Charts of 45 consecutive patients were analyzed, 31 men and 14 women, and they were divided in two groups, considering previous irradiation therapy. Nonirradiated group had 33 patients, and irradiated group had 12 patients. In total, 138 implants were installed, 42 (30.4%) in previously irradiated bone. RESULTS The overall implant survival rate was 96.4% with a success rate of 99.0% among the nonirradiated patients and 90.5% among the irradiated patients (p = 0.03). CONCLUSIONS Results showed that irradiated sites had a worse prognosis related to success of osseointegration, although the 90.5% survival rate in this group indicates that implant placement is a feasible alternative to anchor orbit prostheses considering the benefits that this technique offers to patients.

Effects of ionizing radiation on bone neoformation: histometric study in Wistar rats tibiae

PURPOSE Comparing the ionizing radiation effects on bone neoformation of rats tibiae previously submitted to radiotherapy with a single dosage of 30Gy with the contralateral tibiae that have received secondary radiation. METHODS In thirty male Wistar rats, 30 days before surgical procedure when round defects would be created on the bone, the right tibia was irradiated with 30Gy and the left tibia received a calculated secondary radiation dose of 7Gy. Sacrifices were performed after 4, 7, 14, 21, 56 and 84 postoperative days and both tibiae were removed for histological processing. RESULTS The left tibiae that received the dose of 7Gy has shown more bone neoformation from 14(th) postoperative days, giving evidences of less damage to cellular population responsible by bone neoformation. On the other hand, the dose of 30Gyon right tibiae did not exhibit significant differences among the periods, suggesting damage of long-lasting or even permanent duration. CONCLUSION Tibiae submitted to radiation dose of 30Gy have shown more damage to bone cells than tibiae that received secondary radiation dose of 7Gy, especially observed on 14(th), 56(th) and 84(th) postoperative days.

Oral Manifestations, Gingival Index and Dental State of Vesiculobullous Diseases

Objective: To determine the occurrence of oral manifestations, gingival index, dental state and associated therapeutic aspects in patients with vesiculobullous diseases. Study design: Prospective and observational study conducted with 69 patients from May 2013 to May 2014 at the Dermatology Outpatient Clinic of the Clinical Hospital, University of Sao Paulo Medical School, Brazil. Data were analyzed for frequency in absolute values, percentage and correlation using the Chi-square test. Results: 84.1% of the patients had oral manifestations of vesiculobullous diseases (p = 0.001); 25% had gingival lesions; 18.2% had lesions in the buccal mucosa, and 17.6% in the lips, with no correlation between the location and the type of disease (p = 0.990). Among all patients with bullous pemphigoid, linear IgA dermatosis, and mucous membrane pemphigoid, 59 (93.6%) patients had gingival inflammation of dental origin but without significant correlation (p = 0.42). There was correlation between pemphigus vulgaris and periodontal disease (p = 0.05). Conclusion: Gingival inflammation seems to interfere negatively with the clinical course of these diseases. Further studies should be conducted to better clarify the interrelations between dental and gingival state, and between vesiculobullous diseases and oral involvement.

Oral Cancer Knowledge Assessment: Newly Graduated versus Senior Dental Clinicians

The present study assessed the level of dentists’ knowledge regarding oral cancer in the city of Sao Paulo, Brazil. A questionnaire was used to compare the level of knowledge among newly graduated and senior clinicians. A total of 20,154 e-mails were correctly delivered to the dentists registered in the database of the Regional Dentistry Council of Sao Paulo, and 477 (2.36%) responses were received. This sample consisted of 84 newly graduated clinicians and 105 senior clinicians. For the statistical analysis, the chi-square test and the logistic regression analysis were performed with α = 0.05, and the results were described herein. According to their knowledge level, the results were statistically different between the groups, since 19% of the newly graduated clinicians were evaluated with knowledge grade A (excellent) in comparison to 6.7% of the senior clinicians. In spite of the results indicated that newly graduated clinicians’ knowledge regarding oral cancer was 2.1 times higher, 34.5% of the professionals in this group had regular or poor knowledge on the subject, and several questions relating to clinical characteristics and risk factors indicated that there still exist some knowledge gaps, demonstrating that there is a need for further studies and information activities addressing oral cancer.

Quality of life assessment of patients utilizing orbital implant-supported prostheses

STATEMENT OF PROBLEM Evaluate the effect of orbital prosthesis retained by implants through a specific quality of life (QOL) questionnaire provides important information on patients QOL, great incentive for the multidisciplinary team and public health support to continue work in this area. PURPOSE The objective of the study was to evaluate patient satisfaction with orbital implant-supported prostheses using an adapted quality of life questionnaire. MATERIALS AND METHODS Forty five patients using orbital implant-supported prostheses for a period ranging from six to 120 months. The subjects answered a questionnaire that consisted of 10 questions covering appearance, retention, conspicuousness, self-confidence, difficulty of placement, difficulty of removal, cleaning, limitation of activities, discomfort of tissues, and recommendation of the method to other patients. Answers were expressed using a visual 100-mm scale. The arithmetic mean of the responses was converted into a percentage to represent the satisfaction index. RESULTS Patients demonstrated a high level of satisfaction on all items, with the lowest rate being for aesthetics and the highest being for recommending the method to other patients. High satisfaction rates regarding the placement and removal of the prosthesis, discomfort to the tissues, and cleaning suggest the ease of handling of the prosthesis. High satisfaction with retention, self-confidence, conspicuousness of the prosthesis, and limitation of activities indicated an association with a better social life. CONCLUSIONS The results showed that use of bone anchorage technique of extraoral prostheses provided a high level of satisfaction among patients, confirming that osseointegrated implants are a very important resource for the rehabilitation of orbital deformities.

Influence of implant-retained silicone oculo-palpebral prosthesis on stress distribution: a pilot study using a photoelastic model.

PURPOSE The purpose of this pilot study was to evaluate the behavior of stresses surrounding orbital model implants subjected to a load of a silicone oculo-palpebral prosthesis. MATERIALS AND METHODS A photoelastic model was constructed mimicking the orbital cavity of an adult patient who underwent left orbital resection. Two 3.75 × 5-mm extraoral implants with 3.75 × 5.25-mm magnetic connectors were placed in the model to anchor a silicone oculo-palpebral prosthesis. The stress generated by prosthesis retention was evaluated using photoelasticity at 15, 30, and 60 minutes. The polariscope images were analyzed qualitatively at five areas surrounding the implants. These same areas were analyzed quantitatively using Matlab software based on the RGB color pattern. Data were compared with the Wilcoxon test. RESULTS Using fringe localization, the qualitative analysis demonstrated that the area between the implants had the greatest stress. The quantitative analysis showed that the peri-implant stress increased significantly in proportion to the increase in prosthesis retention time. CONCLUSION The oculo-palpebral prosthesis generated stress around the implants, and the stress intensity was directly proportional to the duration of use.