Rafael Martínez-Conde

Warthin tumor: A new hypothesis concerning its development

OBJECTIVE Warthin tumor is the second most common benign parenchymal salivary neoplasm. The purpose of this study was to evaluate the histopathologic features of Warthin tumor to determine whether a developmental pattern could be identified. STUDY DESIGN Seventy-nine Warthin tumors in 63 patients (62 male and 1 female; average age, 58.62 years) were examined. All cases were histopathologically classified and morphometrically analyzed with an Optomax system to measure the proportions of lymphoid tissue and cystic cavities. RESULTS The predominantly epithelial type (21% of all cases) of Warthin tumor was associated with a mean patient age at diagnosis of 53 years, a mean evolution time of 2.8 months, an average size of 1 cm, and a mean lymphoid component of 10%. In the case of the classical type (61% of all cases), the mean patient age at diagnosis was 58 years, the mean evolution time 9 months, the average size 2.4 cm, and the mean lymphoid component 40%. For the predominantly lymphoid type (18% of all cases), these values were, respectively, 62 years, 11 months, 2.8 cm, and 74%. The mean size of the classical and lymphoid tumors (79% of the Warthin tumors) was significantly greater (p < 0.0001) than the mean size of the epithelial type (21% of the Warthin tumors). A positive correlation between tumor size and evolution time was found. CONCLUSION Our results suggest that the Warthin tumor initially develops as an adenomatous epithelial proliferation followed by lymphocytic infiltration.

Primordial odontogenic tumour: clinicopathological analysis of six cases of a previously undescribed entity

To describe the clinicopathological and immuno‐histochemical features of six tumours that do not fulfil the criteria of any of the currently classified odontogenic tumours.

Overexpression of cyclooxygenase-2 as a biomarker in different subtypes of the oral lichenoid disease

OBJECTIVE Oral lichenoid disease (OLD) includes a number of chronic inflammatory processes including oral lichen planus (OLP) and oral lichenoid lesions (OLL) with controversial diagnosis and prognosis. Cyclooxygenase-2 (COX-2) is a key enzyme for inflammatory processes and cellular proliferation. Its overexpression in some premalignant chronic inflammatory diseases and malignant neoplasias could point to its potential as a prognostic factor. The aim of this study was to analyze the COX-2 expression in different subtypes of OLD because of its potential to be a marker of altered behavior. STUDY DESIGN Forty-four samples from OLD patients were studied (30 females and 14 males) and classified according to their clinical (C1: only papular lesions/C2: papular and other lesions) and histological features (HT: OLP typical/HC: OLP compatible) according to published criteria. Standard immunohistochemical procedure was performed for COX-2 expression and a comparative and descriptive statistical analyses were performed. RESULTS Epithelial COX-2 overexpression was observed in 24 (54.5%) cases (C1: 13 [54.2%]/C2: 11 [45.8%], HT: 9 [37.5%]/HC: 15 [62.5%], P = .032). Inflammatory COX-2 overexpression was observed in 14 (31.8%) cases (C1: 6 [42.9%]/C2: 8 [57.1%], HT: 4 [28.6%]/HC: 10 [71.4%], P = .032). CONCLUSION Differences in COX-2 expression in subtypes of OLD may distinguish cases with a higher premalignant potential.

Ancient Schwannoma of the hard palate : an uncommon case report and review

Schwannoma or neurilemmoma is an infrequent benign tumor in the oral cavity that originates from the Schwann cells on the neural sheath of the peripheral nerves. Schwannomas are frequently located in the soft tissues of head and neck region, but only a 1 to 12% of them are located in the oral cavity. Some histological variants of schwannoma have been described including the cellular, plexiform, epithelioid, ancient, and melanocytic types. The “ancient schwannoma” is an uncommon variant of this tumor that shows specific histological characteristics, and is rare in the oral cavity with less than 15 cases described on the literature. Most of them were located in the tongue or in the floor of the mouth, being the hard palate an extremely rare localization. We present a new clinical case of an ancient schwannoma with a long time of evolution, arising from the nasopalatine nerve, and located in the hard palate of a 35 year old female. We also review the main clinical and histological characteristics of this pathology. Key words:Ancient schwannoma, neurilemmoma, palate, schwannoma.

Bone Microbial Decontamination Agents in Osseous Grafting: An In Vitro Study With Fresh Human Explants

BACKGROUND Establishing a safe prophylactic antimicrobial protocol in bone grafting may enhance osseous volume outcomes. The purpose of this in vitro study is to assess human osteoblast response and safety after explant antimicrobial exposure. METHODS Fresh human bone explants were exposed to three antimicrobials: povidone-iodine (PovI; 0.05%, 1%, and 5%), chlorhexidine (CHX; 0.2% and 1%), and sodium hypochlorite (NaOCl; 2.5%, 4.5%, and 5.25%) at different times (15, 30, 45, and 60 seconds) and concentrations to assess cellular toxicity. Explants were washed three times with saline after exposure. Controls, explants cultured in the absence of antimicrobials, were performed for all experimental situations tested. Trials were conducted in triplicate. Particle size influence on osteoblast growth was determined between bone fragments with a diameter <2 and ≥2 to 5 mm. Test and control groups were monitored by light microscopy to evaluate cellular growth. Osteoblast differentiation and morphology was assessed by alkaline phosphatase activity and scanning electron microscopy (SEM). RESULTS Osteoblast growth was similar for particles <2 and ≥2 to 5 mm. Alkaline phosphatase control reference values were not significantly different from test groups (0.35 mU/mL ± 0.004 versus 0.34 mU/mL ± 0.009; P >0.05). Light microscopy showed on average 97% osteoblastic growth for bone particles exposed to PovI 5% and CHX 0.2% for all times and CHX 1% up to 30 seconds. The odds ratio of positive osteoblastic growth after a 30-second 2.5% NaOCl exposure was 2.4 times higher than after 5.25%. On average, one of two replicas yielded positive growth with 2.5% NaOCl and one of three with 5.25%. After 60-second explant exposure, positive osteoblastic growth was 7.7 times more likely to occur with 5% PovI or 0.2% CHX than with 5.25% NaOCl (P <0.05). SEM analysis confirmed light microscopy similar cellular adhesion and osteoblast phenotypic features between test and control groups. CONCLUSIONS Best osteoblastic growth occurred after bone PovI exposure and CHX 0.2%. Cellular toxicity seems to be influenced by the type of antimicrobial, concentration, and exposure time. SEM analysis confirmed absence of osteoblast phenotypic alterations after exposure. Decontamination agents can safely be used in bone transplantation using up to 5% PovI and 0.2% CHX for 1 minute and CHX 1% for 30 seconds.

Gingivostomatitis after eating fish parasitized by Anisakis simplex: a case report

Anisakis simplex (AS) is a nematode that may be encountered as a parasite in various kinds of seafood. Human beings may accidentally acquire AS larvae by eating raw or undercooked seafood. In addition to human parasitization (anisakiasis), this nematode can induce allergic reactions. AS-related diseases are frequent, especially in those countries with a high level of fish consumption and with traditions of eating raw or undercooked seafood. To our knowledge, this is the first report of gingivostomatitis secondary to the ingestion of fish with AS parasites.

Simultaneous Oral Antral Fistula Closure and Sinus Floor Augmentation to Facilitate Dental Implant Placement or Orthodontics

Several techniques have been used to treat the oroantral fistula with similar rates of success and failure. Some of them frequently present anatomical disadvantages. They can reduce vestibular depth, cause lack of support bone, or cause fusion of the Schneiderian and mucosal membranes. In this report, we present 3 cases of orosinusal fistulas successfully treated with a simultaneous closure of the communication and sinus floor augmentation. At the same time, this technique enables the restoration of the alveolar process with enough bone volume, which facilitates later implant surgery, prosthetic rehabilitation, or even some orthodontic treatments.

Bone Remodeling around Implants Placed in Augmented Sinuses in Patients with and without History of Periodontitis

BACKGROUND Susceptible individuals may be more prone to bone loss after augmentation procedures. PURPOSE Identify plausible clinical and biological factors influencing apical and marginal bone remodeling at implants placed in augmented sinuses, in patients with and without history of periodontitis. MATERIALS AND METHODS This prospective cross-sectional clinical study analyzed implant bone levels in a group of 104 patients with and without history of periodontitis undergoing 139 sinus augmentation procedures. Marginal and apical bone loss (MBL/ABL) was measured post-loading using a standardized digital technique. Measurements were taken preoperatively, at second stage implant uncovery, one year after loading and at an average of 53-months follow-up. Odds ratios were calculated to evaluate risks factors of contributing variables, such as, smoking, history of periodontitis, membrane perforation, surgical approach, grafting material, use of PRP, and implant design/dimensions. RESULTS Patients with history of periodontitis were 8.43 times more likely to present more than 2mm of MBL than patients without it (p =.041; CI95%: 1.09-65.12). Smokers were 4.97 times more likely to present over 2 mm of MBL than non-smokers (p =.003; CI95%: 1.70-14.54). Sinus membrane perforations were 11.4 times more likely to present ABL than those without perforation (p = 0.007; CI95%: 1.94-66.93). Mean MBL/ABL after 1-year post-loading and at last control were 0.49/0.56 mm and 0.67/0.46 mm, respectively. The use of a collagen membrane to cover the antrostomy and only xenograft as grafting material decreased ABL by 0.9 mm. The combination of autologous/xenograft bone was 4.04 times more likely to present higher ABL than xenograft alone (p = 0.023; CI95%: 1.21-13.45). Overall implant survival/success rates were 94.39%/91.33%, respectively. CONCLUSIONS Smoking and previous history of periodontitis negatively affects implant MBL. Sinus membrane perforation was associated with higher ABL. Lack of association between bone remodeling at marginal and apical areas suggests that they are different and independent processes.

Mixoma odontogénico: neoplasia controvertida

Resumen El mixoma odontogenico es una infrecuente neoplasia de los maxilares; benigna, aunque localmente agresiva y muy recidivante. Se origina a partir del ectomesenquima odontogenico y presenta una imagen histologica mixoide anodina. Se diagnostica con mas frecuencia en la segunda y tercera decadas de la vida, y generalmente, a traves del estudio histopatologico, ya que la clinica y la imagen radiologica son inespecificas. Presentamos un caso clinico que manifiesta las caracteristicas clinicopatologicas, histologicas y radiologicas tipicas de esta neoplasia y se discuten sus principales aspectos, algunos controvertidos.

Current understanding of genetic polymorphisms as biomarkers for risk of biological complications in implantology

Background In the last decade, multiple studies have been published that analyze the relationship between the risk of experiencing biological complications with implants and the presence of certain types of genetic polymorphisms. In the present report, we analyze the controversies that have arisen from this important area of investigation and synthesize the most prominent aspects of knowledge related to this possible etiopathogenic relationship. Material and Methods For this review, the biomedical databases PubMed-Medline, SciELO, and DOAJ were used. Different search strategies were employed, from which 298 articles initially emerged. After refinement of the search, 55 articles published between 2002 and 2018 were finally selected based on relevance. Results In certain population groups, there is evidence to support that about a dozen polymorphisms could in some way be related to biological complications in implantology. Indeed, the results may vary according to the ethnic origin of the population studied. Most of the published investigations are initial studies reporting small sample sizes and utilizing different study group homogenization methods. We are still at a preliminary stage of our understanding and development with regard to these types of biomarkers. The interesting results identified indicate that new investigations will be necessary to eliminate the biases observed in some studies and to homogenize the research groups. In order to clarify the controversies surrounding the current knowledge in this field, we believe that it will be necessary to employ larger study groups and search for possible synergistic effects between different polymorphisms. Key words:Polymorphism, genetic markers, peri-implantitis, biological complication, dental implant.