Abstract The mechanisms that stimulate the proliferation of epithelial cells in inflammatory periapical lesions are not completely understood and the literature suggests that changes in the balance between apoptosis and immunity regulation appear to influence this process. Objective: To evaluate the expression of the epidermal growth factor (EGF), its receptor (EGFR) and of the keratinocyte growth factor (KGF), the presence of CD57+ cells, the epithelial cell proliferation index, and the expression of the Bcl-2 protein in inflammatory periapical lesions (IPL) at different stages of development. Methodology: Our sample was composed of 52 IPLs (22 periapical granulomas - PG - and 30 periapical cysts - PC), divided into three groups: PGs, small PCs, and large PCs. Specimens were processed for histopathologic and immunohistochemical analyses. Sections were evaluated according to the amount of positive staining for each antibody. Results: We found no significant differences among the groups regarding Bcl-2 (p=0.328) and Ki-67 (p>0.05) expression or the presence of CD57+ cells (p=0.748). EGF (p=0.0001) and KGF (p=0.0001) expression was more frequent in PCs than in PGs, and CD57+ cells were more frequent in IPLs with intense inflammatory infiltrates (p=0.0001). We found no significant differences in KGF (p=0.423), Bcl-2 (p=0.943), and EGF (p=0.53) expression in relation to inflammatory infiltrates or to the type of PC epithelial lining, but observed greater KGF expression (p=0.0001) in initial PCs. EGFR expression was similar among the groups (p>0.05). Conclusion: More frequent EGF and KGF expression in PCs and the greater presence of CD57+ cells in lesions with intense inflammatory infiltrates suggest that these factors influence IPL development. The greater KGF expression in initial PCs suggests its importance for the initial stages of PC formation.

ABSTRACT Objective To evaluate the effect of the COVID-19 impacts on the activities of researchers in the field of Oral Medicine (OM) and Oral Pathology (OP). To assess the research activities and training of human resources by Brazilian productivity fellows in research (BPFR) in OM and OP in the COVID-19 Era. Material and Methods Thirty-six BPFR in OM and OP areas, funded by National Council for Scientific and Technological Development (CNPq), received a virtual structured questionnaire by e-mail, on the Google Forms (Google®) platform, with questions regarding research activities and training of human resources (supervision of undergraduate and postgraduate students), during the COVID-19 pandemic. From the thirty-six BPFR in OM and OP, twenty-seven (75.0%) answered the questionnaire. Results Most of them were males (n=20; 74.1%) and were distributed in four Brazilian regions and ten states of the federation, including the Federal District. Twenty-four (88.9%) BPFR reported having suspended clinical activities, while sixteen (59.3%) answered that histopathology practices are suspended. Twenty-five (92.6%) BPFR mentioned difficulties in conducting research projects and 55.5% stated having no difficulties in the supervision of undergraduates, master’s and PhD students. Conclusion The current scenario may significantly impact the diagnosis of oral diseases in Brazil. Moreover, a decrease in the scientific production of BPFR in OM and OP in the coming years is also considered.

Abstract Objective: This study evaluated the expression of pro-inflammatory (IL-1β, IL-6, IFN-γ and TNF-α) and anti-inflammatory (IL-4 and TGF-β) cytokines in apical periodontitis lesions. Correlations between these cytokines and clinical and cone-beam computed tomographic (CBCT) data were also assessed. Material and Methods: Apical periodontitis lesions’ data were obtained from 27 patients subjected to periradicular surgery. Specimens were processed for histopathologic and immunohistochemical analysis. Sections were evaluated according to the amount of positive staining for each antibody. Expression levels of the target mediators were compared with clinical and CBCT data. Results: Twenty lesions were diagnosed as granuloma and 7 as cyst. In granulomas, IL-4 expression was significantly higher than IL-6 (p=0.001) and TNF-α (p=0.001). There was a significant relationship between high levels of TNF-α and lesions <5 mm (p=0.017). In cysts, IL-6 expression was significant lower than IL-4 (p=0.001) and IFN-γ (p=0.004). There was a significant relationship between high levels of TGF-β and endodontic treatment performed ≤4 years before (p=0.045). In general, IL-4 was the most expressed mediator in both cysts and granulomas. Conclusions: There was a balance between the expression of pro-inflammatory and anti-inflammatory cytokines associated with the chronic periradicular inflammatory process. TNF-α and TGF-β were related to some clinical and CBCT data.

Resumo O objetivo deste artigo é relatar achados histológicos e tomográficos de aloenxertos ósseos em bloco com implantes dentários em oclusão funcional em um acompanhamento de longo prazo. Quatro pacientes com implantes funcionalmente carregados por 4 anos em rebordos alveolares enxertados, que necessitaram de cirurgia mucogengival ou instalação de implantes adicionais foram incluídos nesta série de casos. Imagens de tomografia cone-beam foram comparados volumetricamente entre o momento inicial (instalação do implante original) e imagens atuais. Biópsias dos enxertos foram coletadas e enviadas para análise histológica. A redução volumétrica dos enxertos variou entre 2,1-7,7%. A avaliação histológica demonstrou enxertos bem incorporados com diferentes graus de remodelação. Embora os dados apresentados neste relato sejam de uma amostra pequena e não permitam conclusões definitivas, as biópsias dos sítios enxertados apresentaram características muito similares ao osso nativo. A remodelação da porção cortical dos aloenxertos parece levar mais tempo do que a porção esponjosa. A presença de remanescentes do enxerto não incorporado não demonstrou impacto no sucesso dos implantes ou na saúde dos tecidos circunjacentes. Este é o primeiro relato com dados histológicos e tomográficos em longo prazo de enxertos ósseos alógenos disponível na odontologia.

Abstract The aim of this paper is to report histologic and tomographic findings of fresh frozen bone block allografts bearing dental implants in functional occlusion in a long-term follow-up. Four patients with implants functionally loaded for 4 years on augmented ridges requiring additional mucogingival surgery or implant placement were included in this case series. Cone-beam tomography scans were compared volumetrically between the baseline (first implant placement) and current images. Biopsies of the grafts were retrieved and sent to histological analysis. Volumetric reduction of the grafts varied from 2.1 to 7.7%. Histological evaluation demonstrated well-incorporated grafts with different degrees of remodeling. While data presented in this report are from a small sample size and do not allow definitive conclusions, the biopsies of the grafted sites were very similar to the host's native bone. Remodeling of the cortical portion of the allografts seems to take longer than the cancellous portion. The presence of unincorporated graft remains did not impair the implant success or the health of the surrounding tissues. This is the first time histologic and tomographic long term data of bone allograft have been made available in dentistry.

Resumo O objetivo deste estudo foi relatar a frequência e os achados clínico-radiográficos dos casos de depressão cortical mandibular lingual diagnosticados em radiografias panorâmicas e em tomografias computadorizadas realizadas pela técnica de feixe cônico consecutivas em uma população brasileira. A metodologia incluiu uma análise retrospectiva de radiografias panorâmicas consecutivas, dos registros dos pacientes da clínica de estomatologia e tomografias computadorizadas consecutivas realizadas pela técnica do feixe cônico. Todos os casos com diagnóstico de depressão cortical mandibular lingual foram selecionados e as informações clínico-radiográficas foram obtidas a partir dos prontuários dos pacientes e da análise dos exames imaginológicos. Um total de 20 casos de depressão cortical mandibular lingual foi diagnosticado em 18 pacientes, incluindo 2 casos em 3.000 radiografias panorâmicas (0,07%), 6 em 2.421 pacientes da clínica de Estomatologia (0,25%) e 10 em 1.684 pacientes do grupo submetido a tomografia computadorizada (0,59%). Os 18 pacientes mostraram uma média de idade de 51,5 anos e 13 eram do gênero masculino. Dois pacientes apresentaram imagens bilaterais. Quatorze imagens (70%) foram classificadas como bem definidas; dezoito acometeram a região posterior da mandíbula e dois casos acometeram a região anterior da mandíbula. O tamanho das lesões foi maior em pacientes mais jovens. Em conclusão, existe uma considerável heterogeneidade na expressão radiográfica das imagens e parece haver uma diminuição do tamanho das imagens com o aumento da idade dos pacientes.

The aim of this study was to report the frequency and clinical-radiological features of cases of lingual cortical mandibular bone depressions (LCMBD) diagnosed in consecutive panoramic radiographs and cone-beam computed tomography (CBCT) scans from a Brazilian population. The methods included a retrospective analysis of consecutive panoramic radiographs, charts from the Oral Medicine clinic and consecutive CBCT scans. All cases diagnosed as LCMBD were selected and clinical-radiological data were retrieved from the clinical charts and by the analysis of the image exams. Twenty LCMBD cases diagnosed in 18 patients were found, including 2 from 3,000 consecutive panoramic radiographs (0.07%), 6 from 2,421 Oral Medicine patients (0.25%) and 10 from 1,684 CBCT scans (0.59%). The 18 patients had a mean age of 51.5 years and 13 were males. Two patients presented bilateral lesions. Fourteen images (70%) were classified as well-defined. Eighteen affected the posterior area of the mandible and two affected the anterior mandible. Size of the lesions was larger in younger patients. In conclusion, there seemed to be a considerable radiological heterogeneity when comparing the LCMBD cases and it seemed that the images decreased in size with the increase of patient's age.

A pneumonia nosocomial, em especial aquela associada à ventilação mecânica, é uma infecção frequente nas UTIs. Seus principais fatores etiológicos incluem bactérias colonizadoras e oportunistas da cavidade oral. Manobras de higiene oral, com o uso de antissépticos orais, como a clorexidina, têm se mostrado úteis na diminuição de sua incidência. O objetivo deste trabalho foi revisar a literatura sobre a importância do microambiente oral no desenvolvimento da pneumonia nosocomial.

Nosocomial pneumonia, especially ventilator-associated pneumonia, is a common infection in ICUs. The main etiologic factors involve colonizing and opportunistic bacteria from the oral cavity. Oral hygiene measures, including the use of oral antiseptic agents, such as chlorhexidine, have proven useful in reducing its incidence. The objective of this article was to review the literature on the importance of the oral environment in the development of nosocomial pneumonia.

Granuloma de colesterol (GC) é uma reação de corpo estranho a deposição de cristais de colesterol, usualmente encontrado em associação com doenças crônicas do ouvido médio, sendo bastante incomum nos seios paranasais. O objetivo deste artigo é relatar um caso de GC no seio maxilar de um homem de 22 anos de idade, manifestando-se como aumento de volume na maxila direita, associado a dor e obstrução nasal. Cortes de tomografia computadorizada (TC) mostraram opacificação completa do seio maxilar direito com expansão e destruição do osso cortical. A biópsia revelou uma massa sólida ocupando o seio maxilar e o exame histológico mostrou uma reação de corpo estranho aos cristais de colesterol. Os achados microscópicos associados à vitalidade dos dentes, imagens em TC e ausência de cavidade durante o procedimento cirúrgico foram compatíveis com o diagnóstico de GC do seio maxilar. A excisão cirúrgica completa da massa sob anestesia geral foi sugerida, mas o paciente não retornou para concluir o tratamento. O GC deve ser incluído no diagnóstico diferencial das doenças que causam opacificação dos seios paranasais, especialmente as sinusites e lesões císticas e tumorais.

Cholesterol granuloma (CG) is a foreign body reaction to the deposition of cholesterol crystals, usually found in association to chronic middle ear diseases, being highly uncommon in the paranasal sinuses. This article reports a case of CG in the maxillary sinus of a 22-year-old man, manifesting as a swelling on the right maxilla associated with pain and nasal obstruction. Computed tomography (CT) imaging showed complete opacification of the right maxillary sinus with cortical bone expansion and destruction. Incisional biopsy showed a solid mass filling the sinus and histological examination showed foreign body reaction to cholesterol crystals. The microscopic findings associated to tooth vitality, CT images and absence of a cavity during the surgical procedure were compatible with the diagnosis of CG of the maxillary sinus. Complete surgical excision of the mass under general anesthesia was suggested, but the patient did not return to conclude the treatment. CG must be included in differential diagnosis of diseases that cause opacification on the paranasal sinuses, especially sinusitis, and cystic and tumoral lesions.

Hemofilia é uma alteração hemorrágica hereditária comum, entretanto pouco se sabe a respeito da microbiota oral destes indivíduos. O objetivo deste estudo foi quantificar a presença de Candida e identificar as suas espécies na saliva de hemofílicos, correlacionando os resultados com fatores clínicos que possam influenciar a presença deste fungo. Foram avaliados 86 hemofílicos do Hemocentro/UNICAMP e 43 indivíduos saudáveis. Todos os pacientes foram submetidos a anamnese, exame clínico intra-oral e coleta de saliva de forma não estimulada. A quantificação e identificação das espécies de Candida foram realizadas nas amostras de saliva. Candida estava presente em 64% dos hemofílicos e em 44% dos indivíduos saudáveis. C. albicans representou 65% e 68% das espécies identificadas, nos hemofílicos e grupo controle respectivamente, e C. tropicalis foi a segunda espécie mais comum. Estes resultados sugerem que pacientes hemofílicos albergam mais freqüentemente Candida na cavidade bucal e em maiores quantidades que os indivíduos do grupo controle, independentemente dos parâmetros clínicos analisados, como infecção viral, próteses dentárias, transfusões de hemoderivados e fluxo salivar.

Hemophilia is a common hereditary hemorrhagic disorder, however little is known about the oral microflora of hemophilic patients. The aim of this study was to quantify the Candida and identify its species in non-stimulated saliva of hemophilic patients, and consider its relationship with clinical factors influencing Candida carriage. This study comprised evaluation of 86 hemophilic patients of the Hematology Center/UNICAMP and 43 healthy subjects as controls. All patients were submitted to anamnesis, intraoral examination and unstimulated saliva collection. Candida counts and species identification were performed in salivary samples. Candida was present in 64% of the hemophilic patients and in 44% of the healthy controls. C. albicans represented 65% and 68% of the isolated species, in hemophiliacs and control group respectively, and C. tropicalis was the second most common species in both groups. These results indicate that hemophilic patients carry Candida more frequently and in higher counts than healthy controls, independently of oral clinical parameter considered, as viral infections, complete dentures, transfusions of hemoderivatives, and salivary flow.