Comparison between periodontal disease and a gingival carcinoma with emphasis on radiographic imaging

The majority of published papers deal mainly with prevalence, pathogenesis and treatment of squamous cell carcinoma of the gingiva (SCCG). On the other hand, little is discussed about the comparison between periodontal disease and gingival carcinoma with emphasis on radiographic imaging. In this case report we discuss the importance of the radiographic aspects in inflammatory periodontal disease and SCCG. This case report shows the importance of differentiating a localized severe periodontal disease and SCCG considering the radiographic aspects of the inflammatory bone loss and tumoral bone loss. The oral health care providers need to be familiar with the radiographic imaging of periodontal disease and SCCG.

Tratamento do sorriso gengival: como estabelecer proporção e harmonia

The etiology of gingival smile is multifactorial and the correct diagnosis eill determine a successful treatment planning. Altered passive eruption occurs during the final stages of tooth eruption, when apical migration of the periodontal tissues does not occur, resulting in a distance > 2mm between the alveolar crest and the cement-enamel juncrion. This change leads to the shortening of the clinical crown and even further may lead to excessive gingival exposure. For treatment, there is a necessity for the combined removal of gingiva and bone tissue. This article discusses the literature on the issue and reports a case where periodontal plastic surgery was performed for the correcrion of a gingival smile.

Conduta no tratamento de gengivite ulcerativa necrosante (GUN) em serviço de urgência

Necrotizing ulcerative gingivitis is a periodontal disease which suddenly appears and presents an acute clinical course, characterized by patients' pain, discomfort and halitosis. Ulceration on papilla and marginal gingiva can be observed. For this reason, patients presenting this condition may seek dental assistance in Health Units or Graduation Institutions, being the dentist responsible for the adoption of a clinical treatment that minimizes symptomatology. The purpose of this case report is to expose and discuss aspects of clinical treatment for this disease applied to the reality of this service.

Uma opção terapêutica para o aumento da faixa de gengiva inserida: o enxerto de tecido conjuntivo livre

Several periodontal procedures have been described in the literature to correct mucogingival alterations or to achieve root coverage. The epithelized free gingival graft is a well established periodontal surgery to increase the width of keratinized gingiva with good stability in the long term follow up. However, this procedure is not commonly used in aesthetic areas since the grafted tissue presents differences of color and contrast. The free connective tissue graft emerges as a viable option to increase attached gingiva in areas where aesthetics results are required. The removal of an epithelized free gingival graft from the hard palate region creates a sore and raw surgical wound that slowly repairs, while the connective tissue graft produces only a line of incision that can be easily sutured promoting a more confortable outcome for the patient. This paper aims to report a case where a free connective tissue graft was used to increase the width of attached gingiva in a tooth with gingival recession. This technique presented satisfactory esthetics results, with a better contrast and color matching with the surrounding tissues.

Complicações Associadas aos Enxertos Ósseos Aposicionais com Osso Autógeno

Introdution: Tooth extraction results in alveolar ridge resorption due to the progressive reabsorption, which frequently is a limitating factor of dental implants treatment, in function of the insufficient bone height for execution, could be indicated the use of grafts for increase of the alveolar edge. However, the success of the bone graft requests the meticulous attendance of the clinical stages. Proposition: The objective of this research was to evaluate the postoperative complications associated to the autogenous bone grafts. Materials and Methods: Through a random retrospective analysis, 90 file records of patients submitted to the surgical procedure of autogenous bone graft in the period of January from 2000 to the March of 2008. A clinical record was elaborated with base in the necessary data for this evaluation. Results: About the file data analysis, 59 female with average of 49,42 years and 31 male with average of 47,90 years. The previous diseases most related were arterial hypertension, stomachache and diabetis. The smokers was noticed in 13,3% of patients. The donor site most used was a mandibular ramus. The postoperative complications in receiving area represented 17,8% of file datas analysed and in the donor site only one patient showed parestesis. Conclusion: Among the total analyzed files it was observed that the postoperative complications associated with the autogenous bone grafts represented 18,9% of the patients submitted to the procedure, more frequently affecting the receiving area, obtaining partial exposure of the bone graft and absence of inserted gingiva on vestibular cortical bone.

The H2S-releasing naproxen derivative, ATB-346, inhibits alveolar bone loss and inflammation in rats with ligature-induced periodontitis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of LPS treatment on the viability and chemokine synthesis by epithelial cells and gingival fibroblasts

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Conduta de tratamento de gengivite ulcerativa necrosante (GUN) em serviço de urgência

Necrotizing ulcerative gingivitis is a periodontal disease which suddenly appears and presents an acute clinical course, characterized by patients' pain, discomfort and halitosis. Ulceration on papilla and marginal gingiva can be observed. For this reason, patients presenting this condition may seek dental assistance in Health Units or Graduation Institutions, being the dentist responsible for the adoption of a clinical treatment that minimizes symptomatology. The purpose of this case report is to expose and discuss aspects of clinical treatment for this disease applied to the reality of this service.

Eficácia e segurança da ceratoplastia endotelial no tratamento da ceratopatia bolhosa pseudofácia e afácia: revisão sistemática e metanálise

Pós-graduação em Bases Gerais da Cirurgia - FMB

Do anticoagulant and antiplatelet agents prevent acute graft thrombosis in renal transplantation? A meta-analysis of case series studies

Introduction & Objectives: Thrombosis of the renal allograft is expected to occur in 1–6% of kidney transplants, and graft loss is expected in almost all cases. Anticoagulant and anti-platelet agents could serve as an adjunctive preventive measure, but sound evidence of benefits are still lacking, in this setting. We therefore assessed the efficacy and safety of anticoagulant and anti-platelet agents, in reducing the rate of renal allograft thrombosis. Methods: A review of the literature was carried out in major databases (MEDLINE, EMBASE and LILACS), with a comprehensive search strategy, to locate all available case series studies of anticoagulant and/or anti-platelet prophylaxis of thrombosis in renal transplantation. The date of the last search was 11 August 2014. We pooled all case series in a proportional meta-analysis. Statistical significance was achieved if the 95% confidence intervals obtained for each intervention did not overlap. Results: Our search strategy retrieved 7160 titles, from which 21 case series were chosen for analysis. A total of 3246 patients were identified (1718 treated with antiplatelet and/or anticoagulant agents, and 1528 non-treated control subjects). Allograft thrombosis occurred in 7.24% (95% CI 3.45 to 12.27%) of the patients receiving no intervention, compared to 3.38% (95% CI 1.45 to 6.1%), 1.2% (95% CI 0.6 to 2.1%) and 0.47% (95% CI 0.001 to 1.79%), in the anticoagulant, aspirin, and aspirin + anticoagulant groups, respectively. Bleeding complication rates were 28.0% (95% CI 15.4 to 42.7%) for anticoagulants, compared to 12.13% (95% CI 0.8 to 33.93%) for aspirin + anticoagulant, 0.31% (95% CI 0.0001 to 1.32%) for aspirin, and 6.1% (95% CI 2.2 to 11.7%) for the control group. Conclusions: Aspirin is more effective in reducing allograft thrombosis, after kidney transplantation, whether alone or in association with an anticoagulant, when compared to no drug prophylaxis, and without higher haemorrhagic complication rates. Anticoagulants, when used alone, do not show a beneficial effect on thrombosis rates, additionally yielding higher bleeding rates.

Safety of kidney transplantation using anti-HBc-positive donors

Background. Prospective studies evaluating the risk of hepatitis B virus (HBV) transmission in transplants of kidneys from hepatitis B core antibody (anti-HBc)-positive/ hepatitis B surface antibody (anti-HBs) negative donors are still lacking. The objective of this study was to assess the safety of kidney transplantation with the use of anti-HBc positive donors.Methods. This prospective case series study included 50 kidney transplant recipients from anti-HBc positive donors with or without anti-HBs positivity. Recipients were required to test positive for anti-HBs (titers >10 mUI/mL), regardless of anti-HBc status, and negative for hepatitis B surface antigen (HBsAg). Recipient and donor data were retrieved from medical records, databases, and organ procurement organization sheets. Liver function tests were performed at progressively increasing post-transplantation intervals. Complete serologic tests for HBV were performed before transplantation, 3 and 6 months after transplantation, and annually thereafter.Results. Six months after transplantation, all recipients were negative for HBsAg, HBeAg, anti-HBe, and anti-HBcIgM. No seroconversion was observed among the 20 patients who received kidneys from anti-HBc positive/anti-HBs negative donors. No patient showed elevated liver enzymes during follow-up.Conclusions. Kidney transplantation using organs from anti-HBeIgG positive donors (even when they are concurrently anti-HBs negative) in anti-HBs positive recipients is a safe procedure and may be considered as a way to expand the donor pool.

An uncommon focal epithelial hyperplasia manifestation

Focal epithelial hyperplasia is a rare, contagious disease associated with infection of the oral mucosa by human papillomavirus types 13 or 32, characterized by multiple soft papules of the same color as the adjacent normal mucosa. It mainly affects the lower lip, buccal mucosa, and tongue. The purpose of this case report was to describe a rare verrucal lesion located in the upper gingiva that was clinically and histologically consistent with focal epithelial hyperplasia.

Gingival squamous cell carcinoma: a case report

Squamous cell carcinoma is a malignant epithelial neoplasm characterized by variable clinical manifestations. When located in the gingiva, this neoplasm may mimic common inflammatory lesions. The aim of this study was to report a case of atypical squamous cell carcinoma, in which the patient had no risk factors for the development of this neoplasm. A 61 year old Caucasian female was seen with a 3 month history of a rapidly growing, painful nodule in the gingiva adjacent to tooth #11. Clinical examination revealed a proliferative lesion in the vestibular marginal gingiva of teeth #11 and #12, presenting with purulent exudation. Thus, in view of the clinical symptoms and differential diagnosis of an infectious granulomatous process and malignant neoplasm, an incisional biopsy was obtained from the lesion. The diagnosis of squamous cell carcinoma was made and fourteen days after incisional biopsy, healing was found to be unsatisfactory. The patient was referred for treatment consisting of surgical excision of the tumour. A removable partial denture was fabricated for rehabilitation, one month after surgery of the maxilla; the patient was submitted to dissection of the regional lymph nodes and radiotherapy for an additional 3 months. Three years after the end of treatment, the patient continues to be followed-up and does not show any sign of recurrence. Gingival squamous cell carcinoma is a condition which chance of cure is higher when carcinomatous lesions are diagnosed and treated early. In this instance dentists play an important role in early detection of gingival squamous cell carcinoma.

Analysis of the peri-implant soft tissues in contact with zirconia abutments: an evidence-based literature review

The aim of this study is to evaluate through a literature review, the soft tissue response in contact with zirconia abutments, including case reports comparing prosthetics rehabilitations with zirconia and titanium abutments upto 3 years of follow-up as well as the factors that should be considered on implant's abutment selection. Metallic abutments can provide grayish color when in contact with thin soft tissues which may lead the implant prosthetic treatment to failure. In this context, the abutments of zirconia stand out because there is an excellent linking between esthetics and the health of peri-implant soft tissues. A consult of the published researches was made on the PubMed database from 2000 to September 2012. The including criteria were: literature reviews, clinical studies and case reports in English that focused on the response of the soft tissue in contact with zirconia implant abutments. The studies that were not in English and did not match the tackled issue were excluded. A total of 32 articles were found. According to the search strategy, just 16 articles were selected for this review. Three studies affirmed that zirconia abutments have an excellent soft tissue response; one study showed increased gingival recession with zirconia abutments and nine studies do not stand out any difference on biological behavior between titanium and zirconia abutments. Three studies affirmed that zirconia abutments provide natural gingival appearance, anatomic contour and greater esthetics. The use of zirconia abutments is recommended for anterior regions because of their greater optical properties and esthetic results and more studies should be performed and analyzed longitudinally regarding their biological response. The zirconia abutments have been established to be essential in order to achieve great esthetic results in cases of thin peri-implant soft tissues and in regions where the three-dimensional placement of implants is more superficial.

Clopidogrel enhances mesenchymal stem cell proliferation following periodontitis

Bone formation is dependent on the differentiation of osteoblasts from mesenchymal stem cells (MSCs). In addition to serving as progenitors, MSCs reduce inflammation and produce factors that stimulate tissue formation. Upon injury, MSCs migrate to the periodontium, where they contribute to regeneration. We examined the effect of clopidogrel and aspirin on MSCs following induction of periodontitis in rats by placement of ligatures. We showed that after the removal of ligatures, which induces resolution of periodontal inflammation, clopidogrel had a significant effect on reducing the inflammatory infiltrate. It also increased the number of osteoblasts and MSCs. Mechanistically, the latter was linked to increased proliferation of MSCs in vivo and in vitro. When given prior to inducing periodontitis, clopidogrel had little effect on MSC or osteoblasts numbers. Applying aspirin before or after induction of periodontitis did not have a significant effect on the parameters measured. These results suggest that clopidogrel may have a positive effect on MSCs in conditions where a reparative process has been initiated.