Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e616-e619.

Osteonecrosis of the jaws by intravenous bisphosphonates and osteoradionecrosis: A comparative study.

Bagan JV, Jiménez Y, Hernández S, Murillo J, Díaz JM, Poveda R, Carbonell E, Sanchis JM, Gavaldá C, Scully C.

Hospital General Universitario Servicio de Estomatología Avda. Tres Cruces s/n 46014 - Valencia (Spain) bagan@uv.es.

Aims: We analyze the possible clinical differences between bone jaw exposed areas in ONJ (osteonecrosis of the jaws) and ORN (osteoradionecrosis). Patients and method: Group 1 was composed with 53 ONJ cases and group 2 with 20 ORN cases. In both groups we analyzed, the major size of the exposed bone areas, the number of exposed areas, the location on the jaws and the presence of others associated and severe complications, such as skin fistulas and jaw fractures. We also investigated the possible local aetiology or trigger factor of the lesions. Results: The major size of the bone exposed areas was 2.29+/-2.02(mean +/- std.dev) in group 1 and 2.7+/-2.9 (mean +/- std.dev) in group 2 (p>0.05). The number of exposed areas was 1.8+/-1.34 (mean +/- std.dev) in group 1 and 1.2+/-0.55 (mean +/- std.dev) in group 2 (p>0.05). There were more fractures in the second group (20%) (p<0.05), and skin fistulas (35%) (p<0.05). We found more patients in group 1 in which the dental extraction was the local aetiology of the bone necrosis (35 cases, 66.03%), while in group 2 there were 8 (40%) (p<0.05). Conclusions: In our study with ONJ there were not differences in the major size of the bone exposed areas, but there were more lesions per patient than in group with ORN. The severity of the complications, such as jaw fractures and skin fistulas were higher in ORN, and in this group it was more frequent the spontaneous lesions than in the ONJ where it is more frequent following dental extractions.

Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e620-e627.

Histomorphological study of the bone regeneration capacity of platelet-rich plasma, bone marrow and tricalcium phosphate Experimental study on pigs.

López-López J, Chimenos-Küstner E, Manzanares-Cespedes C, Muñoz-Sánchez J, Castañeda-Vega P, Jané-Salas E, Alvarez-López JM, Gimeno-Sanding A.

Departament d'Odontoestomatologia Pavelló de Govern, 2a planta Despacho 2.29 Av. Feixa Llarga, s/n 08907 L'Hospitalet de Llobregat, Spain, 18575jll@comb.es.

Introduction: Bone defects are rather common after oral surgery and may prove difficult to repair. Objective: We provide a histomorphological analysis of the bone regenerative capacity of platelet-rich plasma at different concentrations and the extraction of platelet-rich bone marrow, compared with beta-tricalcium phosphate. Methodology: We performed an experimental study on 8 pigs, in which we performed trepanations of the mandible in order to place the materials to be studied. Using an electron microscope, we observed the samples obtained and took a series of photographs in order to analyze the samples through a gray-scale histogram system. Results: Ossification phenomena were present in 96% of the charged defects, regardless of the material used to fill it. Platelet-rich plasma (PRP) and the bone marrow (M) showed an equivalent degree of osteogenesis, 12.3 and 13.4 respectively, which is greater in than the control group. The platelet-poor plasma (PPP) shows a capacity similar to the control groups (C), with an average count of 14.03 and 14.12 respectively. Tricalcium phosphate (TP) was shown to be effective as an ossification inducer, 3.03 times stronger than the control group. Conclusions: Ossification occurs in most of the charged defects. PRP and M had the greatest osteogenic capacity but PPP was no more effective than the control .

Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e628-e634.

Retrospective study of a series of 850 patients with temporomandibular dysfunction (TMD). Clinical and radiological findings.

Poveda-Roda R, Bagan JV, Jiménez-Soriano Y, Fons-Font A.

Hospital General Universitario Servicio de Estomatología Avda. Tres Cruces s/n 46014 - Valencia (Spain) poveda@uv.es.

Objective: To define the clinical and radiological characteristics of the four most common presentations of temporomandibular dysfunction-myofascial pain (MFP), disc displacement with reduction (DDWR), disc displacement without reduction (DDWoR), and osteoarthrosis (OR)-and to identify the differences among them. Material and methods: The study comprised a series of 850 patients (121 males and 729 females) seen between May 2003 and December 2006 in Valencia University General Hospital (Valencia, Spain) for temporomandibular joint disease (TMJD). An analysis was made of the possible etiological factors (stress, traumatisms, sleep disturbances, parafunctional habits, reason for consultation), possible pain sensations in response to palpation of the masticatory muscles, joint sounds, etc. A panoramic X-ray study was made on a routine basis, and in some patients (n = 54) the study was completed with a magnetic resonance imaging scan of the temporomandibular joints and related tissues. The differences between qualitative variables were examined by means of the chi-square test with R x C contingency tables and the Z-test, while quantitative variables were contrasted by analysis of variance (ANOVA) and post hoc testing (Scheffe). Results: The variables showing statistically significant differences among the four diagnostic categories were: patient age, sleep disturbances, stress, parafunctional habits, nibbling on hard objects and "other parafunctions", reason for consultation, mandibular movements, "non-evaluable" molar and canine relationship, ligament hyperlaxity, and panoramic X-ray alterations.

Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e635-e639.

Fibronectin as an adjuvant in the diagnosis of oral inflammatory myofibroblastic tumor.

Xavier FC, Rocha AC, Sugaya NN, Dos Santos-Pinto D, de Sousa SC.

Disciplina de Patologia Bucal Faculdade de Odontologia da USP Av. Prof. Lineu Prestes, 2227 São Paulo - SP, Brasil - 05508-900, f.calo@usp.br.

Inflammatory myofibroblastic tumor is a distinctive lesion composed of myofibroblastic spindle shaped cells accompanied by inflammatory infiltrate that may arise in various organs. It is believed to be a noneoplastic inflammatory condition, although this is still controversial. The recognition of inflammatory myofibroblastic tumor as an entity is important especially to avoid unnecessary surgery. A few cases have been reported in the oral cavity. This report primarily presents a case of inflammatory myofibroblastic tumor that arose in the floor of mouth of a 23-year-old woman. The proliferating spindle cells were immunoreactive for vimentin, smooth muscle actin, and muscle specific actin and negative for desmin, AE1/AE3, S-100, CD68, MyoD1 and caldesmon. In an attempt to assess the potential neoplastic nature of this lesion, immunohistochemical expression of ALK protein was performed, although no immunoreactivity was detected. Also, the presence of well differentiated myofibroblasts identified by fibronectin is discussed, as well as the importance in establishing an immunoprofile to better consolidate the diagnosis. We conclude that the study of fibronectin in case series may aid the diagnosis as well as the prediction of the tumor course.

Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e640-e645.

The frequency and characteristics of idiopathic osteosclerosis and condensing osteitis lesions in a Turkish patient population.

Miloglu O, Yalcin E, Buyukkurt MC, Acemoglu H.

Ataurk university, Faculty of dentistry, Department of oral diagnosis and radiology, 25240, Erzurum/Turkey, omiloglu@hotmail.com.

Objectives: The objective of this study was to investigate the frequency of idiopathic osteosclerosis (IO) and condensing osteitis (CO) in a Turkish patient population, considering factors such as age and sex of the population, in addition to shape and localization, as well as the dental relationship between IO and CO lesions. Patients and methods: A retrospective study was performed using panoramic radiographs of 6,154 patients ranging in age from 5 to 69 years old, who had been subjected to dental treatment. Descriptive characteristics of radiopacities, including shape, localization and dental relationship were recorded. The Chi-squared test was used. Results: A total of 238 radiopacities were detected, which included 185 IO lesions in 150 (2.44 %) subjects (96 female, 54 male and mean age: 26.2), and 53 CO lesions in 50 (0.81 %) subjects (27 female, 23 male and mean age: 32.8). Both IO and CO lesions were found to be higher in number among females, as compared to males. However, this difference was statistically significant for IO lesions only (p<0.001). The frequency of IO lesions was found to be significantly higher in the 3rd and 4th decades of life (20-39 years) than in other decades (p<0.001). On the other hand, the frequency with which the CO lesions were detected was similar in ages ranging between 20-39 and 40-69 years old, and its frequency in these periods was noted to be statistically higher than in the 1st and 2nd decades of life (p<0.01). Conclusion: Our results point to the low IO and CO frequency among the Turkish population. In addition, our findings support the theory that IO lesions are developmental variations of normal bone architecture unrelated to a local stimulant, whereas CO lesions could be considered reactive formations related to teeth with severe caries, restoration or pulpitis.

Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e646-e649.

Occupational stress among Brazilian oral-maxillofacial surgeons.

Carneiro SC, Vasconcelos BC, Nascimento MM, Leal JL, Orestes MS, Porto GG.

Faculdade de Odontologia de Pernambuco. Universidade de Pernambuco. Av. General Newton Cavalcanti, 1650 Camaragibe - Pernambuco. CEP: 54753-220 belmiro@pesquisador.cnpq.br.

Purpose: The aim of the present study was to assess the stress level of oral-maxillofacial surgeons, based on the Demand-Control Model. Methods: A cross-sectional study was carried out with 128 oral-maxillofacial surgeons who participated in the Brazilian Congress of Oral-Maxillofacial Surgery held in the city of Florianópolis, State of Santa Catarina, Brazil. Data was obtained using a questionnaire that incorporated the Demand-Control Model (Job Content Questionnaire), which evaluates psychosocial experiences at work. Information on age, gender and professional qualification was also collected. The data was displayed in contingency tables. The following statistical tests were used with a 5% level of significance: chi-square test and "Fisher exact test". Results: Oral-maxillofacial surgeons were classified according to the Demand-Control Model as follows: High Demand (28%), Low Demand (28%); Passive Work (27%), Active Work (16.4%). Conclusion: The majority of oral-maxillofacial surgeons exercise their profession in unsatisfactory working conditions, as less than 1/3 of the population studied worked under the ideal condition of low demand.

Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e650-e653.

Ameloblastic fibro-odontoma: A case report.

Cavalcante AS, Anbinder AL, Costa NC, Lima JR, Carvalho YR.

Av. Engenheiro Francisco José Longo, 777. Jd. São Dimas. São José dos Campos-SP Brazil CEP: 12245-000,anasueli@fosjc.unesp.br.

Ameloblastic fibro-odontoma (AFO) is a rare, benign, slow-growing odontogenic tumor, generally asymptomatic and more prevalent in children and adolescents. We report a case of AFO in the mandible of an eight-year-old Caucasian male patient, and review the literature . Intraoral examination revealed a swelling extending from the deciduous second molar to the retromolar triangle, covered with normal mucosa. A panoramic radiograph showed a large, well-demarcated radiolucency with radiopaque areas. The provisional diagnosis was of AFO, and so an incisional biopsy was performed. Histologically, the lesion was composed of connective tissue resembling the dental papilla, with epithelial strands or islands, as well as denticles and amorphous masses of enamel and dentin consistent with a diagnosis of AFO. Surgical excision and curettage of the lesion were performed. The patient has been monitored for eight years and the lesion has not recurred.

Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e654-e657.

Ameloblastic fibro-odontoma: A conservative surgical approach.

Nascimento JE, Araújo LJ, Almeida LY, De-Paula AM, Bonan PR.

Stomatology Clinic, School of Dentistry, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil,pbonan@yahoo.com.

Ameloblastic fibro-odontoma (AFO) is a rare benign mixed odontogenic tumor that occurs predominantly in children and young adults with no gender predilection and anatomic site, usually appearing as a painless swelling. We present a case of an 11-year-old non-Caucasian boy complaining of large painless isolated swelling in the right mandibular body. Intraoral examination revealed a tumoral mass with cortical bone expansion, covered by normal mucosa measuring 4.0 x 2.0 cm, located on both the lingual and buccal surfaces of the right body of the mandible, with displacement of the neighboring teeth. Panoramic radiography revealed an expansile, radiolucent and well circumscribed lesion with scattered foci of calcified material, which contained several radiopaque bodies of varying sizes and shapes. The provisional diagnoses were odontoma or AFO/ Biopsy confirmed AFO. The patient was treated with conservative surgery. After two years of follow-up, no alteration or recurrence was detected.

Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e658-e662.

In vitro evaluation of the temperature increment at the external root surface after Er,Cr:YSGG laser irradiation of the root canal.

Abad-Gallegos M, Arnabat-Domínguez J, España-Tost A, Berini-Aytés L, Gay-Escoda C.

Centro Médico Teknon, Instituto de Investigación UB-IDIBELL, C / Vilana, 12, 08022 Barcelona, Spain, cgay@ub.es.

Objectives. A study was made to determine the temperature increment at the dental root surface following Er,Cr:YSGG laser irradiation of the root canal. Design. Human canines and incisors previously instrumented to K file number ISO 30 were used. Irradiation was carried out with glass fiber endodontic tips measuring 200 mm in diameter and especially designed for insertion in the root canal. The teeth were irradiated at 1 and 2 W for 30 seconds, without water spraying or air, and applying a continuous circular movement (approximately 2 mm/sec.) in the apico-coronal direction. Results. At the 1 W power setting, the mean temperature increment was 3.84 degrees C versus 5.01 degrees C at 2 W. In all cases the difference in mean value obtained after irradiation versus the mean baseline temperature proved statistically significant (p<0.05). Conclusions. Application of the Er,Cr:YSGG laser gives rise to a statistically significant temperature increment at the external root surface, though this increment is probably clinically irrelevant, since it would appear to damage the tissues (periodontal ligament and alveolar bone) in proximity to the treated tooth.

Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e663-e667.

Costochondral graft with green-stick fracture used in reconstruction of the mandibular condyle: Experience in 13 clinical cases.

Villanueva-Alcojol L, Monje-Gil F, Gonzalez-Garcia R, Moreno-Garcia C, Serrano-Gil H, Maestre-Rodriguez O, Ruiz-Laza L, Manzano-Solo-de Zaldivar D, Mateo-Arias J.

C/ Fernando Sanchez Sampedro, 2,2A, 06003, Badajoz, Spain, laurivillanueva@hotmail.com.

Since its publication in 1920 by Gillies, costochondral grafts have been used by surgeons to replace and injured mandibular condyle and to reconstruct the temporomandibular joint. This procedure is currently applied in cases of congenital dysplasia, developmental defects, temporomandibular ankylosis, neoplastic disease, osteoarthritis and post-traumatic dysfunction. Over the years, various procedures for the reconstruction with this type of graft have been described. In 1989, Mosby and Hiatt described a technique for setting the graft securely, reducing the space between the graft and the mandibular area. In 1998, Monje and Martín-Granizo developed a variation of this method, enabling a precise adaptation of the costochondral graft to the remaining mandibular ramus. The aim of this study is to evaluate the functional and anatomic results of the costochondral graft treatment by green-stick fracture for reconstruction of the TMJ in the 10 years following the description of this technique. We carry out a retrospective study of thirteen cases of temporomandibular pathology (tumors, ankylosis and hypoplasia) treated during a period of ten years from 1998 to 2008. In all these cases, the technique described by Monje and Martín-Granizo was used: removal of the sixth rib, fixation to a titanium mini-plate using screws, making an internal corticotomy in order to obtain a green-stick fracture of the outer cortex, providing adequate adaptation of the graft to the mandibular ramus. The graft was then set in place, attaching it with titanium screws. This technique was successful in achieving optimal ossification, a good interincisal opening and satisfactory cosmetic results. In conclusion, according to our experience, the green-stick fracture for the adaptation of costochondral grafts to the remaining mandibular ramus has presented outstanding results in the surgical treatment of temporomandibular pathology.

Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e668-e673.

The atraumatic restorative treatment approach: An "atraumatic" alternative.

Carvalho TS, Ribeiro TR, Bönecker M, Pinheiro EC, Colares V.

Departamento de Odontopediatria -Faculdade de Odontologia, Universidade de São Paulo, Avenida Professor Lineu Prestes, 2227, Cidade Universitária, CEP. 05508-000 São Paulo-SP, Brazil, thiagosaads@hotmail.com.

Introduction: Fear and anxiety are part of all human experiences and they may contribute directly to a patient's behavior. The Atraumatic Restorative Treatment (ART) is a technique that may be an alternative approach in treating special care patients or those who suffer fear or anxiety. Objective: the aim of this paper is to review the ART technique as an alternative to reduce pain and fear during dental treatment. Material and Methods: A search for the term "atraumatic restorative treatment" was carried out in the MEDLINE search engine. References, from the last 10 years, containing at least one of the terms: "psychological aspects", "discomfort", "fear", "anxiety" or "pain", were selected. Results: A total of 120 references were found, from which only 17 fit the criteria. Discussion: All authors agreed that the ART promotes less discomfort for patients, contributing to a reduction of anxiety and fear during the dental treatment. Results also indicated that ART minimizes pain reported by patients. Conclusions: The ART approach can be considered as having favorable characteristics for the patient, promoting an "atraumatic" treatment. This technique may be indicated for patients who suffer from fear or anxiety towards dental treatments and whose behavior may cause the treatment to become unfeasible or even impossible altogether.

Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e674-e679.

Evaluation of morphological changes produced by orifice opener systems using computerized tomography (CT).

Hervás A, Forner L, Llena C, Zaragoza E.

Clínica Odontológica, Universitat de Valencia, C. Gascó Oliag, 1, 46010 Valencia (Spain), forner@uv.es.

Objectives: To evaluate modifications in root canal morphology following instrumentation with orifice openers using Computerized Tomography (CT). Study design: Experimental in vitro study. A preoperative CT was performed on 49 molars to measure the root canal cross-sections. After preparing the canals with 6 different nickel-titanium (Ni-Ti) rotary system orifice opener type instruments and Gates Glidden burs, a further CT was made and compared with the preoperative one. Kruskal-Wallis and ANOVA statistical analysis were used. Results: Gates Glidden burs were significantly more aggressive in the coronal portion of the canals, although all the instruments removed more dental tissue in the most coronal of the sections studied. Bucco-lingual diameters were modified more than the mesio-distal ones. The stainless steel instruments used lead to greater modifications being required in the canals than those made of nickel-titanium. The ProFile system instruments were observed to be those that caused the least amount of change. Conclusions: Stainless steel burs are more aggressive than new orifice openers without significant differences observed between Ni-Ti instruments.

Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e680-e685.

Host defence mechanisms against bacterial aggression in periodontal disease: Basic mechanisms.

Bascones-Martínez A, Muñoz-Corcuera M, Noronha S, Mota P, Bascones-Ilundain C, Campo-Trapero J.

Departamento Medicina y Cirugía Bucofacial. Facultad de Odontología Universidad Complutense de Madrid Plaza Ramón y Cajal, s/n. 28040 Madrid, Spain, antbasco@odon.ucm.es.

Periodontal diseases are complex bacteria-induced infections characterised by an inflammatory host response to plaque microbiota and their by-products. Most of these microorganisms have virulence factors capable of causing massive tissue destruction both directly, through tissue invasion and the production of harmful substances, or indirectly, by activation of host defense mechanisms, creating an inflammatory infiltrate of potent catabolic activity that can interfere with normal host defense mechanisms. In response to the aggression, host defense mechanisms activate innate and adaptive immune responses. Our aim is to offer a general overview of the main mechanisms involved in the host response to bacterial aggression in periodontitis, such as lipopolysaccharide receptor CD14, complement system, polymorphonuclear neutrophils, antibodies and immunoglobulins.

Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e686-e726.

[Abstracts from the X International congress of the Spanish Society of Oral Medicine. Cadiz, Spain, 11-13 Jun 2009.]

[Article in Spanish]

Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e727-e801.

[Abstracts from the VII National congress of the Spanish Society of Oral Surgery. Almeria, Spain, 17-19 September 2009.]

[Article in Spanish]

Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e802-e851.

[Abstracts from the VIII International Meeting of the Iberoamerican Academy of Oral Pathology and Medicine. Isla Margarita, Venezuela, 5-8 October 2009.]

[Article in Spanish]