Rafael Lima Verde Osterne

Odontogenic tumors: a 5-year retrospective study in a Brazilian population and analysis of 3406 cases reported in the literature

OBJECTIVE The objective of this study was to analyze the frequency and distribution of odontogenic tumors in Fortaleza, Brazil, and compare the findings with those reported in the literature. STUDY DESIGN A total of 6231 oral lesions retrieved from 5 anatomic pathology services in Fortaleza, Brazil, over a 5-year period, were reviewed. In addition, the literature was searched for studies on odontogenic tumors (OTs) according to the 2005 WHO classification. RESULTS Within the total 6231 oral lesions, 185 (2.97%) were OTs, all benign. OTs presented a female predilection, with a male:female ratio of 0.62:1.00. These neoplasms occurred over a wide range of ages (1 to 78 years), with a mean of 30.5 years. Ameloblastomas, keratocystic odontogenic tumors, and odontomas were the most frequent OT types. CONCLUSIONS OTs are rare neoplasms and appear to show geographic variations. In Fortaleza, Brazil, they are more common in female patients, with ameloblastoma followed by keratocystic odontogenic tumors as the most frequent OTs.

Glucocorticoid and calcitonin receptor expression in central giant cell lesions: implications for therapy.

Central giant cell lesion is an uncommon benign jaw lesion, with uncertain aetiology, and variable clinical behaviour. Studies of molecular markers may help to understand the nature and behaviour of this lesion, and eventually may represent a target for pharmacological approaches to treatment. The aim of this study was to analyse the expression of glucocorticoid and calcitonin receptors in central giant cell lesions before and after treatment with intralesional steroid. Paraffin-embedded blocks from patients who underwent treatment with intralesional triamcinolone hexacetonide injections were stained immunohistochemically. Biological material from patients who underwent a surgical procedure after treatment were tested immunohistochemically. 18 cases (9 aggressive and 9 non-aggressive) were included. The difference in calcitonin receptor expression was not statistically significant between the aggressive and non-aggressive lesions and between the patients with a good response and those with a moderate/negative response to treatment. Glucocorticoid receptor expression in the multinucleated giant cells was higher in patients with a good response. It can be postulated that immunohistochemical staining for glucocorticoid receptors may provide a tool for selecting the therapeutic strategy. An H-score greater than 48 for glucocorticoid receptors in multinucleated giant cells predicted a good response in this study.

Intralesional corticosteroid injections in the treatment of central giant cell lesions of the jaws: a meta-analytic study.

Objective: The aim of this study was to evaluate the response of treatment of central giant cell lesion to intralesional corticosteroid injections. Study Design: Review of articles indexed in PubMed on the topic between the years 1988 and 2011, and development of a descriptive meta-analysis of the results. Results: Sample of 41 patients primarily treated with intralesional corticosteroid injections was obtained, with a male female ratio of 1:0.95, being 23 aggressive and 18 non-aggressive central giant cell lesions. Triamcinolone acetonide and triamcinolone hexacetonide were the drugs used, and 78.0% cases were considered as good result, 14.6% were considered as moderate response and 7.3% were considered as negative result to treatment. Considering the aggressiveness, 88.9% of non-aggressive lesions presented a good response to treatment, in aggressive central giant cell lesions, 69.6% presented a good response to intralesional corticosteroid injections. Conclusion: In view of the results analyzed, intralesional corticosteroid injections could be considered as first treatment option for central giant cell lesion. Key words:Central giant cell lesion, corticosteroids injections, triamcinolone hexacetonide, triamcinolone acetonide.

Alternative Distraction Osteogenesis Technique After Implant Placement for Alveolar Ridge Augmentation of the Maxilla

An alternative technique to reconstruct atrophic alveolar vertical bone after implant placement is presented. The technique consists of distraction osteogenesis or direct surgical repositioning of an implant-and-bone block segment after segmental osteotomies that can be used in esthetic or unesthetic cases. Initially, casts indicating the implant position are obtained and the future ideal prosthetic position is determined to guide the model surgery. After the model surgery, a new provisional prosthesis is fabricated, and an occlusal splint, which is used as a surgical guide and a device for distraction osteogenesis, is custom fabricated. Then, the surgery is performed. For mobilization of the implant-and-bone block segment, 2 vertical osteotomies are performed and then joined by a horizontal osteotomy. The implant-and-bone block segment is moved to the planned position. If a small movement is planned, then the implant-and-bone segment is stabilized; for larger movements, the implant-and-bone segment can be gradually moved to the final position by distraction osteogenesis. This technique has good predictability of the final position of the implant-and-bone segment and relatively fast esthetic rehabilitation. It can be considered for dental implants in regions of vertical bone atrophy.

Autotransplantation of Immature Third Molars and Orthodontic Treatment After En Bloc Resection of Conventional Ameloblastoma

Ameloblastoma treatment can lead to significant bone defects; consequently, oral rehabilitation can be challenging. We present the case of a 14-year-old girl diagnosed with a conventional ameloblastoma in the mandible who was treated using en bloc resection and rehabilitated with autotransplantation of the immature third molars and orthodontic treatment. The lesion was in the region of the lower left canine and premolars, and en bloc resection resulted in a significant alveolar bone defect. Autotransplantation of the lower third molars to the site of the lower left premolars was performed. After 2 years, the upper left third molar was transplanted to the site of the lower left canine. During the orthodontic treatment period, considerable alveolar bone formation was observed in the region of the transplanted teeth, and roots developed. To the best of our knowledge, this is the first reported case of alveolar bone formation induction caused by tooth transplantation after ameloblastoma treatment.

Quantification of bone gain in central giant cell granuloma of the jaws submitted to intralesional corticotherapy

Introduction: The central giant cell granuloma (CGCG) is a bone alteration of unknown etiology that can affect the jaws and presents varied clinical behavior. Objective: To analyze radiographs from patients with CGCG submitted to intralesional corticosteroids, in order to quantify bone gain after treatment. Methods: Sixteen patients with the microscopic diagnosis of CGCG were selected from the Batista Memorial Hospital, in Fortaleza, Ceará, Brazil. Thirty-two radiographs (16 initial and 16 final) were evaluated by the mean pixel values of the affected region before and after the complete corticosteroid intralesional application protocol (six applications in biweekly intervals of triamcinolone hexacetonide). Results: Of the patients submitted to the study, 14 (87.5%) presented a mean increase in the values of pixels, understood as bone gain, in the radiographs after treatment with intralesional injections, and two (12.5%) did not present it. The comparison of the mean pixel values between the initial and final test sides showed p = 0.0027, which was statistically significant, confirming the increase in density in the studied regions. Conclusion: The tools for analysis of pixel values were useful in the quantification of bone gain in patients submitted to intralesional corticosteroid therapy, and these tools should be further explored and used during treatment as auxiliary methods in the evaluation of its efficacy.

A retrospective study of an alternative technique for implant repositioning in the maxillary esthetic region

BACKGROUND Implant-bone block segment repositioning may be an option of treatment for patients with vertical alveolar bone atrophy. PURPOSE To assess implant-bone block movement, gingival outcome and the subjective appreciation of patients after an alternative treatment of an implant-bone block segment repositioning in the maxillary esthetic region. MATERIALS AND METHODS Patients who underwent implant-bone block segment relocation in areas of vertical alveolar bone atrophy in the anterior esthetic region were assessed. The outcome measures were implant failure, complications after initial loading, vertical bone augmentation, papilla index, width of the keratinized mucosa, and patient satisfaction. RESULTS Twenty-five implants in nine consecutive patients were included in this study. During the follow-up period, only one implant failed. Vertical bone augmentation ranged from 3.0 to 8.4 mm (mean 4.9 mm). A significant improvement (P < .001) in the papilla index was observed, improving the esthetic outcome. Six patients (66.6%) had more than 2 mm of keratinized mucosa and all of the patients were satisfied with the treatment. CONCLUSIONS The esthetics and functional gingival outcome of oral rehabilitation in areas with vertical alveolar bone atrophy can be successfully improved with the presented technique, which had a high overall implant survival rate within a short period.

Terapia conservadora para lesão central de células gigantes: relato de caso

Case report of central giant cell lesion (CGCL) in a 32-year-old female patient, who exhibited asymptomatic increase in mandible volume and integrity of the adjacent alveolar mucosa, she was submitted to conservative treatment. The imaging exams showed radiolucent and multilocular lesion with displacement and discrete root resorption of the teeth 34 and 35. An incisional biopsy was performed and the final diagnosis of CGCL was established. The patient was submitted to biweekly applications of triamcinolone hexacetonide, showing no recurrence and exhibiting bone reintegration. Treatment of extensive lesions with intralesional corticosteroid injections has shown satisfactory effects.