Viviane Almeida Sarmento

Assessment of disk displacements of the temporomandibular joint

The aim of the present research was to evaluate disk displacements (DDs) of the temporomandibular joint (TMJ) among patients referred for magnetic resonance imaging (MRI) scans, and analyze the type and prevalence of DD, gender, age, side distribution, reciprocal clicking, presence of pain, range of mouth opening movement, and dental condition. The sample comprised 113 patients, 12-78 years old (the age average was 36.4 +/- 13.5 years), 92 females and 21 males, who underwent MRI between July 2001 and December 2002. A Signa Horizon system (GE) MRI scanner was used at a magnetic field magnitude of 1.5 T with a bilateral radiofrequency surface coil (6.5 x 6.5 cm). Twenty-three (20.4%) patients were found to be normal, whereas 90 (79.7%) presented with DD. Anterior DD (61.1%) was the most common type of articular disk displacement. Males and females were equally affected (no statistically significant difference). We did not find a statistically significant association between DD and increased age. Bilateral DD (70%) was the most common DD occurrence. We found a statistically significant association between reciprocal clicking and anterior DD with reduction. We did not find a statistically significant association between DD and pain, be it articular or facial pain, otalgia or cephalgia. We found a statistically significant association between anterior DD without reduction and mouth opening limitation. With regard to oral condition, we did not find a statistically significant association between DD and loss of teeth.

Clear cell odontogenic carcinoma: case report with immunohistochemical findings adding support to the challenging diagnosis

Clear cell odontogenic carcinoma (CCOC) is a rare odontogenic tumor associated with aggressive clinical behavior, metastasis, and low survival. We report a case of CCOC affecting the mandible of a 39-year-old man. The tumor presented a biphasic pattern composed of clear cell nests intermingled with eosinophilic cells and separated by collagenous stroma. Immunoreactivity to cytokeratin (CK), specifically AE1/AE3 and CK 8, 14, 18, and 19 was found, as well as to epithelial membrane antigen (EMA). The tumor cells were negative for S100 protein, CK 13, vimentin, smooth muscle actin, laminin and type IV collagen. Low labeling indices for the proliferation markers Ki-67 and proliferating cell nuclear antigen and to p53 protein might predict a favorable prognosis for the lesion. A surgical resection was performed, followed by adjuvant radiotherapy. A 2-year follow-up has shown no signs of recurrence. The significance of histochemical and immunohistochemical resources in the correct diagnosis of CCOC is analyzed.

Effect of different surface processing protocols in three-dimensional images for rapid prototyping

The aim of the study was to evaluate the accuracy of virtual three-dimensional reconstructions of human dry mandibles, produced with different surface processing protocols. Three-dimensional images were built from computed tomography scans of 10 dry mandibles, and the surface was smoothed, refined, or both, generating 30 different images. Linear measurements from anatomical landmarks were calculated and compared with the corresponding measurements of the original dry mandible (gold standard). The results showed no differences between the models that were just refined or just smoothed (p>0.05), when compared to the gold standard. When these two tools were applied together, there was a statistically significant difference (p<0.01). In conclusion, the application of a single processing tool (smoothing or refinement) in the virtual models does not affect the anatomical measures. However, the simultaneous application of both tools increases the differences between the reconstructions and the original anatomical parts.

Effect of osteoporosis on periodontal therapy among post-menopausal women

OBJECTIVE This intervention study aimed to investigate the effect of osteoporosis on periodontal condition among 48 post-menopausal women undergoing periodontal therapy. MATERIAL AND METHODS The experimental group, which underwent non-surgical periodontal therapy, was composed of 16 women with periodontitis to be treated, and the control group was formed by 32 women without periodontitis. Oral condition was assessed on three occasions: at the start of the treatment (first examination), 1 month (first re-examination) and 4 months after the end of the therapy (second re-examination). In the second re-examination, recurrence of periodontal disease was evaluated by comparing the clinical measurements obtained pre- and post-treatment. The diagnosis of osteoporosis was made by investigating densitometry reports obtained previously. Descriptive analysis, analysis of variance and the Bonferroni post hoc test were applied to the data gathered, with statistical significance level of 5%. RESULTS The frequency of periodontitis was 50% in the treated group and 25% in the group without periodontitis. In both groups, this recurrence was greater in subjects with osteoporosis (37.5 and 18.75%, respectively) than in the individuals without osteoporosis (12.5 and 6.25%, respectively). CONCLUSIONS The preliminary results indicate that osteoporosis possibly has an influence on periodontal condition among individuals undergoing non-surgical periodontal treatment.

Porphyromonas gingivalis antigens differently participate in the proliferation and cell death of human PBMC

OBJECTIVE Modulation of cell-mediated immunity by microorganisms in periodontal diseases has been widely studied; however, the proliferative activity and/or programmed death of mononuclear cells under periodontopathogenic stimuli are not yet well understood. The aim of this study was to investigate in vitro proliferation and death of peripheral blood mononuclear cells (PBMC) upon stimulation with Porphyromonas gingivalis (Pg) antigens. DESIGN In 19 patients with chronic periodontitis (CP) and 16 controls without periodontitis (NP) the following clinical parameters were evaluated: bleeding on probing, probing depth, and clinical attachment level. PBMC were cultured under Pg stimuli and apoptosis/necrosis and proliferation assays were carried out for 18 and 48 h, respectively. Fluorescence of labelled cells was determined using flow cytometry. RESULTS PBMC of CP and NP subjects exhibited a lower proliferative response to Pg LPS (p<0.05) and HmuY protein (p<0.001) compared with non-stimulated cells. Early apoptosis was induced by Pg LPS (p<0.01) and Pg extract (p<0.05), whilst all antigens induced late apoptosis (Pg LPS: p<0.001; Pg extract: p<0.001; HmuY: p<0.01) and necrosis (Pg LPS: p<0.01; Pg extract: p<0.001; HmuY: p<0.001). Pg LPS induced higher late apoptosis than HmuY (p<0.05). Only Pg LPS-induced necrosis tended to be higher in CP compared with NP. CONCLUSIONS The inhibitory effect of cell proliferation caused by Pg LPS and HmuY protein is not observed when these antigens comprise Pg extract. Despite induced apoptosis, some still unknown mechanism determines the inflammatory outcome in cell death stimulated by HmuY.

Evaluation of bone repair after radiotherapy by photobiomodulation-an animal experimental study

This research evaluated the effect of GaAlAs lasertherapy at the healing of surgical wounds produced in Wistar rat femurs a few days before the beginning of the radiotherapy. An orifice was artificially produced in the femur bone of the rats and they were submitted to an external radiotherapy with a radioactive source of cobalt in the dosage of 3000 cGys. The experimental group received additionally seven sessions of 780 nm, 40 mW, 100 or 5 J/cm2 in four points around the surgical wound, at each 48 h, initiated at the day of surgery. These animals were then sacrificed at three and five weeks. The results were based on the clinical and histological analyses. Clinically, even though the rats had gained body mass within the time of the experiment (p < 0.05), those who has been submitted to the lasertherapy presented cutaneous inflammatory reactions. Regarding the histological findings, the number of osteocites (p < 0.0001) and Harvers channels (p < 0.0001) was significantly larger in the groups that had been radiated with laser during the experiment.

Articulação temporomandibular - aspectos normais e deslocamentos de disco: imagem por ressonância magnética

O deslocamento de disco da articulacao temporomandibular tem sido definido como uma relacao anormal do disco articular com o condilo mandibular, fossa e eminencia articulares. Os deslocamentos de disco podem estar presentes sem interferir com a funcao articular a curto prazo. A ressonância magnetica tem sido o exame de imagem de primeira escolha para o diagnostico das anormalidades de tecido mole da articulacao temporomandibular, uma vez que apresenta alta acuracia na determinacao da posicao do disco articular. O objetivo deste trabalho e apresentar uma revisao de literatura, demonstrando os aspectos normais e os diferentes tipos de deslocamentos de disco desta articulacao e o seu diagnostico por imagem, destacando o papel do exame por ressonância magnetica.

Satisfaction of skeletal class III patients treated with different types of orthognathic surgery

The aim of this study was to compare the satisfaction of skeletal class III patients following treatment with three different methods of orthognathic surgery. Eighty-two patients were divided into three groups according to the surgical procedure performed to correct their class III dentofacial deformity, and answered a questionnaire designed to determine the patients opinion of the aesthetic and functional treatment outcomes. Differences in the patterns of responses to questions in the questionnaire related to satisfaction between the three clinical groups were evaluated by χ(2) and Fishers exact tests (α=5%). Eighty patients (97.6%) reported being satisfied with the treatment received. There was no significant difference in response patterns among clinical groups when assessing the improvement in facial appearance, chewing, speech, and socialization. Maxillary advancement led to higher levels of improvement in breathing (P<0.0003). Class III patients treated by orthognathic surgery had high levels of satisfaction with the aesthetic and functional outcomes of their treatment.

Extensive Gingival Hemangioma in a 10-Year-Old Boy Treated by Sclerotherapy: A Case Report

f n o Because of imprecise medical terminology, the descriptions of vascular anomalies were somewhat unclear until the 1980s. Mulliken and Glowacki introuced a simplified classification in 1982 based on linical, histochemical, and cellular criteria to distinuish among various types of vascular anomalies. Vasular lesions of the oral and maxillofacial region were ivided into 2 categories: benign vascular tumors haracterized by endothelial proliferation and vasular malformations with no endothelial proliferaion. Hemangiomas are rapidly growing benign vascular tumors that often manifest in the neonatal period or during childhood. Characterized by a slow rate of regression and incomplete involution, these tumors affect female patients more frequently than male patients (3:1) and rarely recur when treated success-

Psammomatoid juvenile ossifying fibroma: case study and a review

BackgroundThe group of fibro-osseous lesions from the maxillofacial region is very heterogeneous, but what they all have in common is the substitution of normal bone by fibroblasts with the consequent formation of collagen fibers, as well as substitution by different types of mineralized tissues which may be similar to bone or cement. Within this group of lesions, the juvenile ossifying fibroma is found, considered a rare and recurrent benign fibro-osseous neoplasia. The term juvenile ossifying fibroma has been used in the literature to describe two histopathological variations of conventional ossifying fibroma. These variations are trabecular juvenile ossifying fibroma and psammomatoid juvenile ossifying fibroma. Psammomatoid juvenile ossifying fibroma is an uncommon bone-forming neoplasm with aggressive local growth. Diagnostic of this lesion occurs after the correlation of clinical, imaging, and histopathological findings. Proposed treatments range from enucleation and curettage to resection of the tumor.ObjectivesThe present article has as its objectives to report an uncommon case of a 4-year-old male patient treated by conservative approach and revise the literature on juvenile ossifying fibroma.ConclusionsPsammomatoid juvenile ossifying fibroma, for its being very uncommon, warrants further investigation in order to establish the best treatment, principally in children, with a view to minimizing mutilating treatments. In the case examined, a conservative treatment was chosen, where the surgeon established curette and cryotherapy, and the reintegration of the child in his social environment, without relapse during the first year of therapy.