Marcelo Marcucci

Assessment of osteoporotic alterations in achondroplastic patients: a case series

Achondroplasia (ACH) is the most common form of human dwarfism and has been associated with biochemical alterations of the bone tissue, also observed in cases of osteoporosis. The present case series aimed at assessing low bone density, diagnosed with spinal bone mineral density (BMD) analysis and with panoramic radiograph measurements, in ACH patients. Spinal BMD was measured by means of dual-energy X-ray absorptiometry at the lumbar region (L1–L4). On dental panoramic radiographs of the patients, the mandibular cortical width was measured separately on the right and left sides. The Klemetti Index was also assigned as appropriate for evaluating the cortical area below the mandibular foramen. Additional parameters such as patient age, gender, body mass index, and number of teeth were also recorded. BMD results showed that 5/11 cases presented with skeletal osteopenia/osteoporosis diagnoses. Additionally, mandibular cortical erosion was detected in panoramic radiographs in 8/11 cases. The BMD and panoramic radiographic alterations found in this study suggest that the diagnosis of low bone density may have a special clinical relevance in cases of bone tissue disorders, such as achondroplasia.

Odontoameloblastoma: report of two cases.

Odontoameloblastoma (OA) is a very rare mixed odontogenic neoplasm, characterized by the simultaneous occurrence of an ameloblastoma and a compound or complex odontoma in the same tumor mass. To date, less than 50 cases of OA and/or ameloblastic odontoma have been reported in the English dental literature. This neoplasm was called ameloblastic odontoma. The term OA was included in the 1971 WHO classification. In this study, we present two cases of OA, which we hope will contribute to the awareness and knowledge of surgeons regarding the existence of this odontogenic tumor so that patients having it may be treated and followed-up properly.

New Uses for Rehabilitation Protocol for Oral Sinus Communications in ARONJ Patients

This report presents a new use for rehabilitation protocol for oral sinus communications in patients with antiresorptive agent-induced osteonecrosis of the jaw. The treatment plan consisted of constructing an atraumatic complete denture with rounded edges, made with nontoxic resin, to prevent any injury to the mucosa and recurrence of the disease. The patient was followed up for 4 years, without any complications, and was socially reintegrated by resuming the normal life he experienced before tooth loss.

New rehabilitation protocol for oral sinus communications in BRONJ patients.

Sir, The management of bisphosphonate-related osteonecrosis jaw (BRONJ) is challenging because most surgical and medical interventions may not eradicate it. More alarming is performing prosthetic rehabilitation of these patients, subject not enough discussed in the literature. The demand of BRONJ patients in need of prosthetic rehabilitation has being dramatically increased in Brazil. We believe that this is also a huge problem in others countries too. The professionals are concerned about the possible induction of new lesions due to trauma caused by the fabrication and use of prostheses. However, the oral rehabilitation of BRONJ patients is of paramount importance for their quality of life. For circumvent this problem our research group in the School of Dentistry of the University of São Paulo developed a new protocol for obtaining prosthesis with chemical and mechanical characteristics conferring an atraumatic and atoxic pattern (Table 1). After more than 4 years of follow-up there is no recurrence of the BRONJ lesions. There is a lack of information on the use of osseointegrated implants in these patients, thus, due to the long half-life of BFs in the patients, or because patient will be still using BFs, new BRONJ lesions can occur, particularly in areas subject to trauma, our group opted for a denture fabrication based on those indicated for patients irradiated for head and neck cancer. Several parameters were considered for the construction of such prosthesis, including resin type, polymerization cycle, prosthesis finishing and internal adaptation, as described in the chart below. We believe that oral health professionals and their BRONJ patients worldwide will be beneficiated with this prosthetic rehabilitation protocol. We hope to have more discussion about this subject for now on.

Mantle cell lymphoma: involvement of nodal and extranodal sites in the head and neck, with multifocal oral lesions

Mantle cell lymphoma (MCL) is a malignant B-cell neoplasm, which comprises monomorphic and small- to medium-sized mantle zone-derived lymphoid cells. It is characterized by chromosomal translocation t(11;14)(q13;q32) and CCND1 truncation, resulting in cell cycle deregulation. It is an aggressive type of non-Hodgkin lymphoma with a propensity to present with extranodal involvement. This study shows the case of an 80-year-old Caucasian male who complained of a 2-month progressive swelling on the right side of his face. The magnetic resonance imaging exam showed multifocal involvement of the head and neck, including oral manifestations, bilateral parotid glands, palate, tongue, and floor of the mouth. An incisional biopsy of the tumor mass was performed. The morphological and immunophenotypic findings were consistent with the diagnosis of MCL. The patient died 4 months later, without any chance of undergoing a therapeutic approach. Although MCL is a rare condition, it should be subjected to a differential diagnosis when affecting the maxillofacial area. Imaging exams and both immunohistochemical and morphological analyses are needed to reach the correct diagnosis. Here, we present an unusual MCL with multifocal involvement of the head and neck.

Des radiopacités mâchoires multiples

Un patient noir, âgé de 60 ans, est venu consulter pour une augmentation de volume des mâchoires avec issue de pus. Ce patient présentait depuis deux ans une augmentation de volume des arcades dentaires avec perte des rapports interarcades. Dans les antécédents, on relevait une hypertension artérielle contrôlée, un diabète décompensé et une augmentation du périmètre crânien apparue à l’âge de 11 mois, à la suite d’une méningite. Il souffrait d’un genu varum avec claudication et une hypertrophie des mains. Il présentait une hypertrophie osseuse bilatérale frontale, occipitale, maxillaire et mandibulaire et des fistules cutanées en regard des deux angles mandibulaires. La muqueuse buccale avait un aspect normal, avec une hypertrophie des arcades dentaires

Manifestação da artrite psoriática na articulação temporomandibular - características imaginológicas

A artrite psoriatica e uma artropatia cronica de etiologia e patogenese nao totalmente esclarecidas, que, embora rara, pode acometer a articulacao temporomandibular. E definida como psoriase associada com artrite inflamatoria, erosiva e cronica, a qual e soronegativa para o fator reumatoide. Objetivo: O objetivo do presente estudo e apresentar uma revisao de literatura sobre as caracteristicas imaginologicas da artrite psoriatica na articulacao tempoporomandibular. Revisao da literatura: A artrite psoriatica pode se apresentar por diversos padroes de envolvimento articular com graus variados de severidade, seguido um curso desde uma leve sinovite a uma artropatia erosiva progressiva. A elaboracao do diagnostico diferencial pode apresentar variados graus de dificuldade. Assim, uma historia detalhada do paciente e exame fisico geral sao de extrema importância para elaboracao do diagnostico e devem ser considerados quando da avaliacao das imagens das lesoes articulares. O uso da tomografia computadorizada no diagnostico de artrite psoriatica deve fazer parte do processo de avaliacao. A ressonância magnetica, o ultrassom e a cintilografia tem papel importante no diagnostico precoce da artrite psoriatica na articulacao temporomandibular e no monitoramento da evolucao da doenca, podendo indicar, inclusive, a alteracao do seu tratamento. Consideracoes finais: Conclui-se que a artrite psoriatica envolvendo a articulacao temporo-mandibular tem como caracteristicas a dor e a limitacao funcional, causando destruicao progressiva dos componentes osseos e dos teciduais articulares, claramente indicada em exames imaginologicos. Assim, a ressonância magnetica assume papel fundamental no diagnostico, monitoramento da evolucao da doenca e na orientacao quanto ao seu tratamento.

Juvenile idiopathic arthritis with involvement of the temporomandibular joint: the role of image examinations

OBJETIVO: A artrite idiopatica juvenil (AIJ) tem etiologia desconhecida e o envolvimento da articulacao temporomandibular (ATM) e raro no estagio inicial da doenca. Este artigo descreve o uso de imagens de tomografia computadorizada (TC) e de ressonância magnetica (RM) para o diagnostico de ATM afetada pela AIJ. DESCRICAO DO CASO: Uma paciente de 12 anos de idade, leucoderma, portadora de AIJ com envolvimento de multiplas articulacoes foi encaminhada ao Centro de Imaginologia para avaliacao das ATMs. A paciente relatou dor na ATM e limitacao de abertura bucal. O exame com TC helicoidal da regiao da ATM com reconstrucoes a 1 mm mostrou assimetria entre os condilos mandibulares, erosao do condilo direito e formacao osteofitica. O exame de RM mostrou erosao do condilo mandibular direito, osteofito, deslocamento sem reducao e ruptura do disco articular. CONCLUSAO: As desordens de ATM devido a AIJ devem ser cuidadosamente examinadas por modernas tecnicas de imagem. A TC e muito util para a deteccao e avaliacao de estruturas osseas da ATM e permite o exame de alteracoes osseas discretas, que nao seriam identificadas por radiografias convencionais nas fases iniciais de AIJ. A RM permite a avaliacao de tecidos moles, identificacao de inflamacao articular aguda e diferenciacao entre hipertrofia sinovial e do pannus.