Maria Cristina Zindel Deboni

Osteonecrose maxilar associada ao uso de bisfosfonatos

Bisphosphonates (BPs) have been used for the management of bone metabolic diseases. Currently their therapeutic use has increased, as also have their adverse effects, one of the most important being the bisphosphonate-related osteonecrosis of the jaw (BRONJ), a complication of difficult treatment and solution. Until now, the physiopathology of BRONJ remains unclear, and its treatment is uncertain. Although the literature provides several treatment options, there is no defined protocol. We present a review about BRONJ, focusing on its pathogenesis and its reported forms of treatment.

Surgical management of dentigerous cyst and keratocystic odontogenic tumor in children: a conservative approach and 7-year follow-up

Dentigerous cyst (DC) is one of the most common odontogenic cysts of the jaws and rarely recurs. On the other hand, keratocystic odontogenic tumor (KCOT), formerly known as odontogenic keratocyst (OKC), is considered a benign unicystic or multicystic intraosseous neoplasm and one of the most aggressive odontogenic lesions presenting relatively high recurrence rate and a tendency to invade adjacent tissue. Two cases of these odontogenic lesions occurring in children are presented. They were very similar in clinical and radiographic characteristics, and both were treated by marsupialization. The treatment was chosen in order to preserve the associated permanent teeth with complementary orthodontic treatment to direct eruption of the associated permanent teeth. At 7-years of follow-up, none of the cases showed recurrence.

Clinical, radiological and histological features of calcifying epithelial odontogenic tumor: case report

The calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic neoplasm that accounts for approximately 1% of all odontogenic tumors. Its origin is controversial as well as its true malignant potential. A case of an advanced CEOT associated with an impacted right second molar in the mandible of a young black female patient is presented. Computed tomography imaging, radiographic and pathological findings, surgical patterns, gross anatomy of the lesion and the performed treatment are discussed.

Analgesic and adjuvant anesthetic effect of submucosal tramadol after mandibular third molar surgery

OBJECTIVE The aim of this study was to assess analgesic and adjuvant anesthetic effects of submucosal tramadol after third molar extraction. STUDY DESIGN In this double-blind, split-mouth, placebo-controlled, single-dose, crossover investigation, 52 patients underwent mandibular third molar extraction under local anesthesia. Surgical side was randomly assigned to submucosal 2 mL 100 mg tramadol injection (group T) or normal saline solution (group P) immediately after surgery. Anesthetic blockade duration, time of intake and amount of analgesic rescue drug, and postoperative pain intensity were recorded immediately after anesthesia cessation and 4, 8, 24, 48, and 72 hours after surgery. Data were submitted to analysis of variance and Wilcoxon tests. RESULTS Anesthetic blockade duration between groups was similar. Group T took significantly less rescue drug after 72 hours (P = .008). Time elapsed before first intake of rescue drug was longer (P = .006), and pain intensity was significantly lower (P = .001) in group T. CONCLUSIONS Submucosal tramadol injection after oral surgery improved postoperative analgesia, but did not extend anesthetic action duration.

Cirurgias odontológicas em usuários de anticoagulantes orais

In the daily medical practice there has been an increase in the use of anticoagulant drugs; as a consequence, dental offices are receiving more individuals under this therapy. Nowadays dental surgeons need a broader knowledge of hemostasis and associated therapies in order to offer the best possible assistance. This article presents a retrospective study based on the clinical records of anticoagulated patients using dicoumarin who underwent dental surgical procedures. Twenty-six patients were submitted to forty-seven minor dental surgical procedures without any change to their doses of anticoagulants. Laboratorial evaluations of PT (pro-thrombin time) based on the INR (International Normalized Ratio) were performed for all patients. The results showed that only one patient reported postoperative bleeding which was controlled by local compression. Based on the results of this study and a brief review of publications, the authors suggest that the most adequate conduct for most patients is to maintain anticoagulation therapy and the complementary use of local hemostasis when necessary.

Mucormycosis in an immunocompetent patient: Follow-up of 1 year after treatment

Mucormycosis is a rare acute fatal fungal infection. It is typically observed in diabetic or immunocompromised patients but not in systemically healthy individuals. Here, we describe an unusual mucormycosis case in an immunocompetent patient who had clinical signs of a maxillary sinusitis and associated osteomyelitis at the first examination. He was treated by surgery and removal of the necrotic bone and amphotericin B medication. At 1-year follow-up he shows complete recovery.

The influence of statins on osseointegration: a systematic review of animal model studies

Recent research data have suggested that the beneficial action of statins in bone tissue could improve osseointegration around titanium implants by increasing the bone implant contact (BIC), the expression of bone morphogenetic protein-2 (BMP-2) and vascular endothelial growth factor (VEGF). The aim of this systematic review was to evaluate the influence of statins on osseointegration of titanium implants in animal studies. Two reviewers searched independently four databases (MEDLINE, SCOPUS, WEB OF SCIENCE and the Cochrane Library), until March 15, 2016. The Cochrane Collaborations Tool for Assessing Risk of Bias was used to assess the quality of the included studies. Papers that reported outcome data considering bone implant contact (BIC), mechanical tests or other histological evaluation were eligible for inclusion. 312 references were eletronically retrieved, 21 full-text papers were screened and 17 studies were included. Thirteen trials presented histomorphometry data on bone implant contact measures. All of them showed a significant improved BIC when using statins. Despite data from included studies point to beneficial effects, standardized studies and with less risk of bias, are needed to clarify the role of statins on osseointegration.

Accuracy of perioperative mandibular positions in orthognathic surgery.

Mandibular position is an important parameter used for the diagnosis of dentofacial deformities, as well as for orthognathic surgery planning and execution. Centric relation (anterior and superior relationship of the mandibular condyles interposed by the thinnest portion of their disks against the articular eminencies), centric occlusion (when lower teeth contact upper teeth at centric relation), and maximal intercuspation (complete interdigitation of lower and upper teeth) are not often addressed as factors that influence the results of orthognathic surgery, although these relationships are critical to ensure accuracy during the surgery. The present study assessed occlusal measurements taken before and after the induction of general anaesthesia from consecutive orthognathic surgery subjects. The variables assessed included the differences between these occlusal measurements, patient age, gender, type of deformity, and type of proposed orthognathic surgical procedure. The results demonstrated statistically significant differences for mandibular retrusion from maximal intercuspation to centric occlusion position, whereas the mandible appeared not to change significantly from centric occlusion after the induction of general anaesthesia. Patient age and the type of deformity appeared to influence the results. While in most instances centric occlusion can be adequately reproduced under general anaesthesia, for some specific orthognathic cases more accurate results might be obtained if the mandible-first sequence is used.

Melanotic Neuroectodermal Tumor of Infancy in the Maxilla

Melanotic neuroectodermal tumors of infancy (MNTIs) are rare fast-growing tumors with high recurrence rates. These tumors, which originate in the neural crest, commonly occur in the anterior maxilla of children under the age of one. Here, we describe an MNTI case in a two-month-old girl with increasing swelling in the left cheek. MNTI was diagnosed in this case following tomography and biopsy. The patients histological and immunohistochemical profile indicated a remarkable combination of neural, melanocytic, and epithelial cell differentiation. One year following tumor excision, a follow-up examination revealed that the child exhibited no tumor recurrence. Approximately 260 cases of MNTI have been reported since this type of tumor was first described. In the present case, early diagnosis minimized the difficulties and risks associated with treatment and facilitated an optimal outcome. Despite complete surgical excision, careful followup is recommended. In addition, maxillary functional orthopedics and reconstruction may be necessary in cases of MNTI.

Dental implant loss in older versus younger patients: a systematic review and meta‐analysis of prospective studies

The aim of this systematic review was to evaluate implant loss in younger and older patients. An electronic search of four databases (MEDLINE, EMBASE, SCOPUS and the Cochrane Library) was undertaken until May 2016 without time restriction and was supplemented by manual searching. Prospective cohorts were included if they met the following criteria: (i) presence of an exposed group (older subjects) with a minimum age of 60 years; (ii) presence of a control group (younger subjects) with a maximum age of 59 years; and (iii) outcome data considering implant survival or loss. Meta-analyses were performed to evaluate the impact of ageing on implant failure. Of 4152 potentially eligible articles, four were included in the qualitative analysis and quantitative synthesis. The pooled estimates suggest that the risk of implant loss in older patients is not significantly higher (RR = 0·92; 95% CI 0·43-1·96, P = 0·83) when compared to younger subjects. This systematic review suggests that age is not a limiting factor for dental implant therapy.