Saulo Gabriel Moreira Falci

Morphological characterization of the nasopalatine region in human fetuses and its association to pathologies

The nasopalatine region is composed of structures such as the vomeronasal organ and nasopalatine duct. The nasopalatine duct may provide the communication of the mouth to the nasal cavity in human fetuses and can be obliterated in an adult human. Knowledge on the development of the nasopalatine region and nasopalatine duct in humans is necessary for understanding the morphology and etiopathogenesis of lesions that occur in this region. Objective: The aim of the present study was to describe the morphological aspects of the nasopalatine region in human fetuses and correlate these aspects with the development of pathologies in this region. Material and Methods: Five human fetuses with no facial or palatine abnormalities were used for the acquisition of specimens from the nasopalatine region. After demineralization, the specimens were histologically processed. Histological cuts were stained with methylene blue to orient the cutting plane and hematoxylin-eosin for the descriptive histological analysis. Results: The age of the fetuses was 8.00, 8.25, 9.00 and 9.25 weeks, and it was not possible to determine the age in the last one. The incisive canal was observed in all specimens as an opening delimited laterally by the periosteum and connecting oral and nasal cavity. The nasopalatine duct is an epithelial structure with the greatest morphological variation, with either unilateral or bilateral occurrence and total patent, partial patent and islet forms. The vomeronasal organ is a bilateral epithelized structure located alongside the nasal septum above the incisive canal in all the fetuses. Conclusions: The incisive canal, nasopalatine duct and vomeronasal organ are distinct anatomic structures. The development of nasopalatine duct cysts may occur in all forms of the nasopalatine duct.

Mechanical and photoelastic analysis of four different fixation methods for mandibular body fractures

OBJECTIVE The aim of the present study was to compare four methods of fixation in mandibular body fractures. STUDY DESIGN Mechanical and photoelastic tests were performed using polyurethane and photoelastic resin mandibles, respectively. The study groups contained the following: (I), two miniplates of 2.0 mm; (II) one 2.0 mm plate and an Erich arch bar; (III) one 2.4 mm plate and an Erich arch bar, and (IV) one 2.0 mm plate and one 2.4 mm plate. The differences between the mean values were analyzed using Tukeys test, the Mann-Whitney test and the Bonferroni correction. RESULTS Group II recorded the lowest resistance, followed by groups I, IV and III. The photoelastic test confirmed the increase of tension in group II. CONCLUSION The 2.4 mm system board in linear mandibular body fractures provided more resistance and the use of only one 2.0 mm plate in the central area of the mandible created higher tension.

Assessment of the fixation of mandibular symphysis fractures using conical cannulated screws: mechanical and photoelastic tests.

OBJECTIVE The aim of this study was to use mechanical and photoelastic tests to compare the performance of cannulated screws with other fixation methods in mandibular symphysis fractures. STUDY DESIGN Ten polyurethane mandibles were allocated to each group and fixed as follows: group PRP, 2 perpendicular miniplates; group PLL, 1 miniplate and 1 plate, parallel; and group CS, 2 cannulated screws. Vertical linear loading tests were performed. The differences between mean values were analyzed with the Tukey test. The photoelastic test was carried out using a polariscope. RESULTS The results revealed differences between the CS and PRP groups at 1, 3, 5, and 10 millimeters of displacement. The photoelastic test confirmed higher stress concentration in all groups close to the mandibular base, whereas the CS group showed it throughout the region assessed. CONCLUSIONS Conical cannulated screws performed well in mechanical and photoelastic tests.

Preemptive Effect of Dexamethasone in Third-Molar Surgery: A Meta-Analysis

&NA; The aim of the present study was to assess the effectiveness of preemptive dexamethasone in surgery of the lower third molars and to compare it with other oral anti‐inflammatories. An electronic search was conducted for preemptive effects related to lower third‐molar surgery in 3 separate databases. The variables pain, swelling, and trismus were assessed. Meta‐analysis was used to calculate the pooled effect measures for mean and standard deviation values (95% confidence interval [CI]). Seven split‐mouth clinical trials were selected. Two studies were included in the metaanalysis. Three studies showed a low risk of bias; 2 studies exhibited a moderate risk and 2 a high risk of bias. Dexamethasone was better than nonsteroidal anti‐inflammatories for preemptive effectiveness. Meta‐analysis for swelling confirmed better results for dexamethasone than for methylprednisolone after 2 days (95% CI = ‐1.28 to ‐0.38), 4 days (95% CI=‐1.65 to ‐0.71), 7 days (95% CI=‐1.42 to ‐0.71), and overall (95% CI=‐1.25 to ‐0.72). Dexamethasone was better than methylprednisolone for mouth opening after 4 days (95% CI=0.18 to 1.07). There is insufficient evidence through meta‐analysis to conclude that dexamethasone is better than other nonsteroidal antiinflammatories or methylprednisolone as a preemptive analgesic. The results of this meta‐analysis suggest that dexamethasone is more effective than methylprednisolone for swelling and trismus.

FASN expression, angiogenesis and lymphangiogenesis in central and peripheral giant cell lesions

Central giant cell lesion (CGCL) and peripheral giant cell lesion (PGCL) are non-neoplastic proliferative processes of the jaws. PGCL is a reactive process induced by irritant local factors and CGCL is an intra-osseous lesion of unknown etiology. Both lesions exhibit similar histologic features showing abundant mononuclear cells, admixed with a large number of multinucleated giant cells and a rich vascularized stroma with extravasated erythrocytes, hemosiderin deposition, and blood-filled pools. Recent studies have linked fatty acid synthase (FASN) with angiogenesis. Objective To evaluate angiogenesis and lymphangiogenesis and their relationship with FASN expression in CGCL and PGCL. Material and Methods Thirteen CGCL and 14 PGCL of the jaws were selected for immunoexpression of FASN; CD34 and CD105 (to assess blood microvessel density [MVD] and microvessel area [MVA]); and D2-40 (to assess lymphatic MVD and MVA). Results Within PGCL and CGCL, MVD-CD34 was signifcantly higher than MVD-CD10S, followed by MVD-D2-40. Moreover, a signifcantly higher number of FASN-positive multinucleated giant cells than mononuclear cells were observed. Between PGCL and CGCL, only MVD-CD34 and all MVA were signifcantly higher in PGCL. Positive correlation between MVA-CD10S with FASNpositive mononuclear cells in both lesions was observed. Conclusions Our results show both lesions exhibiting similar levels of FASN expression and neoangiogenesis, suggesting constitutive processes that regulate tissue maintenance.

Fanconi's anemia in dentistry: a case report and brief literature review

PURPOSE: To present a critical analysis of the dental literature about the oral, skeletal and developmental manifestations associated with Fanconis anemia (FA) and to describe a clinical case. CASE DESCRIPTION: Patient: male, Caucasian, 18 years-old. At the physical exam, the patients appearance was roughly that of a 12-year-old child. The oral exam revealed carious lesions, gingivitis, bilateral crossbite and anterior open bite. Several teeth were absent and several primary teeth were present. CONCLUSION: The review of the literature reveals a heterogeneous pattern for the oral manifestations of FA, as observed in the case described in the present report. The most common oral manifestations of the disease are gingivitis, periodontitis, dental agenesis and squamous cell carcinoma.

Relationship between bariatric surgery and periodontal status: a systematic review and meta-analysis

BACKGROUND The effects of bariatric surgery can reflect in the oral cavity and can cause alterations in oral health. This high prevalence of oral alterations in the pre and post-operative periods has been highlighted in different studies. OBJECTIVES To investigate the effect of bariatric surgery on periodontal status through a systematic review. METHODS Electronic search was conducted in PubMed, VHL, Web of Science, Science direct, Scopus, and Cochrane databases through May 2017. Manual search, gray literature, and counter-refence of included articles were also conducted. Eligibility criteria included observational studies that reported periodontal outcomes before and after bariatric surgery. RESULTS Search strategy resulted in 1878 articles. Following the selection process, nine studies were included in the qualitative analysis and five in the meta-analysis. Three cross-sectional studies showed risk of bias score ranging from 5 to 6 stars, and Cohort studies scored from 6 to 9 stars out of 9 possible stars on the Newcastle-Ottawa scale. The quantitative analysis showed that clinical attachment level (MD: 0.07; CI95% -0.17 to 0.31), gingival index (MD: -0.28; CI95% -1.68 to 1.11), percentage of bleeding sites (MD: -0.21; CI95% -0.77 to 0.35), and pocket probing depth (MD: 0.08 CI95% -0.14 to 0.31) were not different before and after bariatric surgery. However, the plaque index was lower after than before bariatric surgery (MD: -1.29; CI 95% -2.34 to -0.24). CONCLUSIONS Plaque index can be improved after bariatric surgery. The present systematic review investigated the association between bariatric surgery and periodontal status from cross-sectional and longitudinal studies. A systematic search strategy was developed until May 2017. The results of this systematic review allowed the conclusion that the plaque index can be improved after bariatric surgery.

Association between developmental defects of enamel and celiac disease: A meta-analysis.

OBJECTIVES Studies have observed the presence of extra-intestinal manifestations of celiac disease (CD), including involvement of the oral cavity, such that developmental defects of enamel (DDE) occur. Thus, the aim of this review was to access the polled prevalence of DDE in individuals with CD, and to establish the strength of the association between these two variables. METHODS To carry out the systematic review, four electronic databases and the Grey Literature were searched, complemented by a manual search of reference lists within the selected articles. Two pairs of independent reviewers selected the articles, and perform the data extractions and bias risk assessment Studies evaluating the presence of DDE in individuals with CD as well as in healthy individuals and which performed the DDE diagnosis by direct visualization of tooth enamel changes and the CD diagnosis were included. Meta-analyses were performed using the software R. RESULTS Of 557 studies, 45 were selected for review, encompassing 2840 patients. The prevalence of DDE in people with CD was 50% (95% CI 0.44-0.57, I2 = 88%). In a general analysis, it was observed that patients with CD had a significantly higher prevalence of enamel defects compared to healthy people (RR: 2.31, 95% CI: 1.71-3.12, I2 = 98%). Only developmental defects of enamel diagnosed using Aines method were associated with the disease (RR: 3.30, 95% CI 2.39-4.56, I2 = 75%). In a sensitivity analysis involving the deciduous, mixed and permanent dentitions, only individuals with deciduous dentition were observed to have association with the disease (RR: 2.34, 95% CI 1.25-4.39, I2 = 39%). CONCLUSIONS Patients with enamel developmental defects should be screened for the possibility of their having celiac disease.

Third molar removal and its impact on quality of life: systematic review and meta-analysis

ObjectiveThe purpose of this systematic review was to assess the impact of third molar removal on patient’s quality of life.MethodsTo address the study purpose, investigators designed and implemented a systematic review. The primary outcome variable was the quality of life after third molar extraction. An electronic search was conducted through March, 2017, on the PUBMED, Virtual Health Library (VHL), Web of Science, and OVID, to identify relevant literatures. Research studies (randomized or non-randomized clinical trials) were included that evaluated the quality of life in individuals before and after third molar extraction, using validated measures of oral health-related quality of life with quantitative approach, besides procedures performed under local anesthesia. The R software was used to measure the mean difference on the quality of life between the preoperative period and follow-up days.ResultsA total of 1141 studies were identified. Of this total, 13 articles were selected in the present systematic review, of which six studies were included in the meta-analysis. All of these 13 articles used the OHIP-14, and 4 of this 13 used OHQoLUK-16 to evaluate the quality of life. Regarding quality assessment, four of the 13 included studies in this review received a maximum score of 9 points, according to the Newcastle–Ottawa (NOS). The OHIP-14 mean score on the first postoperative day was 17.57 (95% CI 11.84–23.30, I2 = 96%) higher than the preoperative period. On the seventh postoperative day, the quality of life assessed by OHIP-14 got worse again.ConclusionThis systematic review revealed that the highest negative impact on quality of life of individuals submitted to third molar surgery was observed on the first postoperative day, decreasing over the follow-up period.

Intramuscular injection of dexamethasone for the control of pain, swelling, and trismus after third molar surgery: a systematic review and meta-analysis

This systematic review aimed to answer the following PICO question: Does the intramuscular injection of dexamethasone result in less pain, swelling, and trismus after mandibular third molar removal when compared to other routes of administration or a control group (saline solution injection or no treatment)? An electronic search was conducted in Virtual Health Library, PubMed, and Web of Science, through March 2018. Eligibility criteria included clinical trials. The search strategy resulted in 331 studies. Following the selection process, 15 articles were included in the systematic review; eight of these were included in the meta-analysis. Most of the studies had an unclear risk of bias (Cochrane Handbook assessment). Pain (mean difference (MD) -1.58, 95% confidence interval (CI) -1.99 to -1.16) and oedema (MD -1.76, 95% CI -2.38 to -1.14) were lower in the intramuscular dexamethasone group when compared to the control group. When compared to the submucosal route, the intramuscular route was more effective only for pain on the third postoperative day (MD -0.79, 95% CI -1.38 to -0.20). The results suggest that the intramuscular injection of dexamethasone may be an alternative route of administration, since it is effective at reducing pain and oedema when compared to non-steroidal treatment and has similar results to the submucosal route.