ABSTRACT Despite being common pathological entities found in the oral cavity, oral mucoceles can present distinct features, raising several diagnostic possibilities and treatments. In this study, we report the case of a 34-year-old man with an asymptomatic increased volume in the left periorbital region of more than a year, without remission or associated trauma. An aspiration biopsy was performed, followed by an excisional biopsy, and the specimen was sent for histopathological examination. Results led to the diagnosis of an oral mucocele. Surgical removal was performed in an excisional biopsy. Subsequently, the patient recovered promptly without further complications. Although oral mucoceles recur relatively often, its prognosis is good. This case emphasizes the importance of obtaining a detailed disease history, knowledge of its clinical features, and etiopathogenesis combined with complementary examinations to establish diagnostic hypotheses and converge on an adequate and individualized treatment plan

RESUMO Apesar de serem entidades patológicas comumente encontradas na cavidade oral, as mucoceles podem apresentar características distintas, o que pode sugerir diversas possibilidades diagnósticas e de tratamento. Paciente do gênero masculino, 34 anos, compareceu ao ambulatório com queixa de aumento de volume assintomático na região periorbitária esquerda há mais de um ano, sem remissão ou trauma associado. Foi realizada biópsia aspirativa seguida de biópsia excisional e a amostra encaminhada para exame histopatológico, que confirmou o diagnóstico de mucocele oral. O paciente evoluiu sem queixas e sem recidiva. Apesar da alta taxa de recorrência, mucoceles orais têm um bom prognóstico. Este relato de caso enfatiza a importância da obtenção de uma história detalhada da doença, do conhecimento de suas características clínicas e da etiopatogenia, para estabelecer hipóteses diagnósticas e convergir para um plano de tratamento adequado e individualizado.

ABSTRACT Synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is an uncommon entity, mostly when the involvement is bilateral. The authors report a rare case of bilateral SC, with a follow-up of 13 months, and a literature review. A 60-year-old Caucasian woman, with the chief complaint of pain for 6 years in the bilateral pre-auricular region, had a progressive clacking and discomfort on the left side during mouth opening. The panoramic image was suggestive of SC. The bilateral lesion was surgically removed by direct access. Histopathological examination confirmed the clinical diagnosis of bilateral SC. This article shows the importance of a multidisciplinary approach for the early diagnosis and appropriate treatment. Also, it encourages the referral of such cases to professionals with a greater familiarity with this entity.

RESUMEN Introducción: la terapia láser de bajo nivel (LLLT por sus iniciales en inglés) se utiliza en diversas situaciones clínicas para el alivio de los síntomas inflamatorios posoperatorios en casos de trastornos temporomandibulares (TTM). Hay muchos protocolos de tratamiento que utilizan radiación láser, pero todavía no hay evidencia de que alguno sea superior a los demás. El objetivo de la presente revisión sistemática consistió en determiner si hay evidencia de que la LLLT pueda reducir los principales síntomas de los TTM y determinar el protocol de aplicación más eficaz. Métodos: se realizó una revisión sistemática de la literatura en las principales bases de datos, PubMed, Scopus y Web of Science, por parte de investigadores independientes que evaluaron los estudios utilizando diferentes protocolos de LLLT para tratar los síntomas de los TTM, considerando resultados específicos como dolor, apertura de la boca y movimientos de la mandíbula. Resultados: trece estudios cumplieron plenamente los criterios de elegibilidad. El tipo de láser más utilizado fue GaAlAg, con una longitud de onda de 830 nm, número de aplicaciones que oscilan entre 8 y 10, y 4 semanas de seguimiento. Conclusiones: la LLLT puede considerarse una alternativa para el alivio de los síntomas de los TTM; sin embargo, no se pudo encontrar evidencia científica de que un protocolo sea superior a los demás.

ABSTRACT Introduction: LLLT is used in various clinical situations for the relief of postoperative inflammatory symptoms in TMD cases. Many treatment protocols use laser radiation, but there is still no evidence as to whether one of them is superior to all the other. The objective was to establish whether there is evidence that LLLT can reduce the main symptoms of TMDs and to determine the most effective application protocol. Methods: a systematic review of the literature was performed in the main databases: PubMed, Scopus and Web of Science, by independent researchers who evaluated studies using different LLLT protocols to treat TMD symptoms, considering specific outcomes such as pain, mouth opening and jaw movements. Results: thirteen studies fully met the eligibility criteria. The most used laser type was GaAlAg, with a wavelength of 830 nm, number of applications ranging from 8 to 10, and 4 weeks of follow-up. Conclusions: LLLT may be considered as an alternative for the relief of TMD symptoms; however, scientific evidence of one of the protocols being superior to the others could not be found.

Resumo Várias técnicas foram propostas para regeneração óssea vertical, e muitas delas usam enxertos ósseos e alogênicos ósseos. O objetivo deste estudo foi comparar os aloenxertos ósseos congelados desmineralizados (DFDBA), os aloenxertos congelados frescos (FF) com os enxertos ósseos autógenos para encontrar diferenças entre o volume, a histologia da formação óssea e a dinâmica do crescimento ósseo vertical. Um modelo ósseo de regeneração tecidual vertical foi realizado em calvarias de coelho sob anestesia geral. Quatro cilindros ocos de titânio puro foram parafusados nas calvarias de osso cortical externo em oito coelhos. Cada um dos cilindros foi preenchido aleatoriamente com uma intervenção: DFDBA, FF, osso autógeno ou com coágulo sanguíneo (BC) como controle. Os enxertos alogênicos foram obtidos a partir de um nono animal seguindo protocolos internacionais padronizados para a coleta, processamento e criopreservação de aloenxertos. O enxerto autógeno foi obtido da raspagem do fêmur do hospedeiro antes de adaptar os cilindros ocos. Os animais foram eutanasiados após 13 semanas. O volume vertical foi calculado após a medição, por meio de sonda milimetrada, do novo tecido formado dentro dos cilindros e após a remoção dos cilindros de titânio. Histomorfometria e coloração com fluorocromios foram utilizados para analisar a quantidade e a dinâmica da formação óssea. Os resultados mostraram que DFDBA e osso fresco congelado melhoraram a velocidade e a quantidade de deposição óssea em porções distantes do plano basal de enxerto. O material remanescente nos grupos de aloenxerto foi mais intenso do que em grupo autógeno. Ambos os aloenxertos podem ser indicados como alternativas confiáveis para ganho de volume e aumento ósseo vertical.

Abstract Several techniques have been proposed for vertical bone regeneration, and many of them use bone autogenous and allogeneic grafts. The purpose of this study was to compare demineralised freeze-dried bone allografts (DFDBA), fresh-frozen (FF) allografts, autogenous bone grafts to find differences between volumetric and histological quantity of bone formation and vertical bone growth dynamic. A vertical tissue regeneration bone model was performed in rabbit calvarias under general anaesthesia. Four hollow cylinders of pure titanium were screwed onto external cortical bone calvarias in eight rabbits. Each one of the cylinders was randomly filled with one intervention: DFDBA, FF, autogenous bone, or left to be filled with blood clot (BC) as control. Allogeneic grafts were obtained from a ninth animal following international standardised protocols for the harvesting, processing, and cryopreservation of allografts. Autogenous graft was obtained from the host femur scraping before adapting hollow cylinders. Animals were euthanized at 13 weeks. Vertical volume was calculated after probe device measurements of the new formed tissue inside the cylinders and after titanium cylinders were removed. Histomorphometry and fluorochrome staining were used to analyse quantity and dynamic of bone formation, respectively. Results showed that DFDBA and fresh-frozen bone improved the velocity and the quantity of bone deposition in distant portions of the basal plane of grafting. Remaining material in allograft groups was more intense than in autogenous group. Both allografts can be indicated as reliable alternatives for volume gain and vertical bone augmentation.

Abstract: The odontogenic keratocyst (OKC) is a recurrent cyst that has been recently reclassified from an odontogenic tumor to an odontogenic cyst. The aim of the present study was to investigate its treatment and address issues related to its association with nevoid basal cell carcinoma syndrome (NBCCS). Lesions from the cohort of patients included in the present study consisted of 40 OKCs, of which 27 lesions were treated by enucleation (GE) and 13 underwent decompression (GD). Complementary treatment occurred in 38 (95%) lesions, of which 10 underwent isolated peripheral ostectomy (GO) and 28 underwent peripheral ostectomy combined with Carnoy's solution (GC). Thirteen lesions were associated with NBCCS (GS), while the others (n=27) were non-syndromic lesions (GnS). The recurrence-free periods (RFP) in the sample groups were compared using the Kaplan-Meier function and log-rank test at a significance level of 5% (p < 0.05) and were used to calculate the cumulative risk of recurrence (CRR) in each postoperative year. During the follow-up period, which had a mean of 43.5 months (range: 12–102 months), six (15%) recurrences were diagnosed. There was no significant difference among the RFP for the compared groups (p > 0.05) or increased CRR for the decompression (15.4%) over five years. Application of Carnoy's solution did not increase the efficacy of the peripheral ostectomy, but was related to a CRR of 0% for the syndromic lesions over five years. Therefore, 1) decompression did not increase the recurrence risk; 2) peripheral ostectomy demonstrated a similar efficacy as the combination with Carnoy's solution; 3) the association of NBCCS did not seem to significantly influence OKC recurrence; and 4) syndromic lesions seem to behave in the same manner as non-syndromic lesions when submitted to complementary treatments.

RESUMO OBJETIVO: Avaliar se um novo cimento bifásico composto por sulfato de cálcio e beta fosfato tricálcico com controle de potencial zeta poderia induzir ou conduzir a neoformação óssea em defeitos críticos. MÉTODOS: Foi feito um defeito crítico de 8 mm de diâmetro na calvária de 40 ratos Wistar machos. No grupo teste (n = 20) os defeitos foram preenchidos pelo cimento. No grupo controle (n = 20) os defeitos não foram preenchidos, permaneceu apenas o coágulo. Os animais sofreram eutanásia em 7, 14, 21 e 42 dias do pós-operatório. Espécimes da calvária foram microtomografados e posteriormente preparados para análise histológica. As análises incluíram a avaliação morfológica da histopatologia do reparo e a avaliação morfométrica da área de formação das trabéculas ósseas comparativamente entre os grupos e coloração histoquímica por meio da fosfatase tartrato-resistente (TRAP) para identificação de osteoclastos. RESULTADOS: As imagens microtomográficas dos defeitos preenchidos pelo cimento não apresentaram diminuição da área de acordo com a progressão dos períodos pós-operatórios. No grupo teste houve permanência do material e resposta corpo estranho até os últimos períodos de observação. A histomorfologia mostrou agrupamentos mais expressivos de células gigantes no grupo teste e osso neoformado mais maduro no grupo controle e comprovou a presença de material exógeno. Na histomorfometria, a área total de neoformação óssea foi significativamente maior (p = 0,009) e crescente no grupo controle. As células gigantes apresentaram expressão histoquímica positiva para TRAP e não foram observados osteoclatos. CONCLUSÃO: O cimento cerâmico não induziu ou conduziu a neoformação óssea sob o ponto de vista microtomográfico e histológico.

ABSTRACT OBJECTIVE: To evaluate whether a new biphasic cement composed of calcium sulfate and beta tricalcium phosphate with zeta potential control could induce or lead to bone neoformation in critical defects. METHODS: A critical defect of diameter 8 mm was made in the calvaria of forty male Wistar rats. In the Test Group (n = 20), the defects were filled with cement. In the Control Group (n = 20), the defect was not filled and only coagulum was present. The animals were sacrificed 7, 14, 21 and 42 days after the operation. Calvaria specimens were subjected to microtomography and were then prepared for histological analysis. The analyses included morphological assessment on the histopathology of the repair; comparative morphometric evaluation of the area of formation of bone trabeculae between the groups; and histochemical staining by means of tartrate-resistant phosphatase (TRAP) in order to identify osteoclasts. RESULTS: Microtomographic images of the defects filled by the cement did not show any decrease in area over the course of postoperative evolution. In the Test Group, the material continued to present a foreign-body response until the last observational periods. Histomorphological analysis showed that there were more significant groupings of giant cells in the Test Group and greater maturity of neoformed bone in the Control Group. Exogenous material was also present. Histomorphometric analysis showed that in the Control Group, the total area of bone neoformation was significantly greater (p = 0.009) and grew progressively. The giant cells presented a positive reaction to TRAP but no osteoclasts were observed. CONCLUSION: The ceramic cement did not induce or lead to bone neoformation from the microtomographic or histological point of view.

Introdução: o deslocamento do disco articular sem redução com abertura limitada é uma desordem intracapsular que envolve o complexo côndilo-disco. Na posição de boca fechada, o disco articular se encontra numa posição anterior em relação à cabeça da mandíbula e não sofre redução com a abertura de boca. Essa desordem está associada à abertura mandibular limitada e persistente.Caso clínico:o paciente relatava travamento da mandíbula que não permitia uma abertura completa da boca, interferindo, assim, na capacidade de se alimentar. Também era possível observar-se uma abertura assistida (alongamento passivo) com uma distância vertical menor que 40 mm entre os incisivos. A ressonância magnética foi o método de escolha para o diagnóstico das desordens temporomandibulares.Conclusão:por meio da descrição de um caso raro de deslocamento anterior do disco articular sem redução e com abertura limitada, após exodontia traumática do terceiro molar inferior, em que foi realizada a redução manual do disco articular da articulação temporomandibular, provou-se ser essa uma técnica eficaz no rápido restabelecimento dos movimentos mandibulares.

Introduction: Disc displacement without reduction with limited opening is an intracapsular biomechanical disorder involving the condyle-disc complex. With the mouth closed, the disc is in an anterior position in relation to the condylar head and does not reduce with mouth opening. This disorder is associated with persistent limited mandibular opening.Case report:The patient presented severe limitation to fully open the mouth, interfering in her ability to eat. Clinical examination also revealed maximum assisted jaw opening (passive stretch) with less than 40 mm of maximum interincisal opening. Magnetic resonance imaging was the method of choice to identify the temporomandibular disorders.Conclusion: By means of reporting this rare case of anterior disc displacement without reduction with limited opening, after traumatic extraction of a mandibular third molar, in which manual reduction of temporomandibular joint articular disc was performed, it was possible to prove that this technique is effective in the prompt restoration of mandibular movements.

Dental pulp has been identified as a novel and promising stem cell source. The following systematic review presents and summarises in vivo studies that have used stem cells from the dental pulp of permanent and deciduous teeth to repair or regenerate non-dental tissues. An electronic customised search was performed using 4 different databases (Entrez PubMed, Cab Abstracts, Scopus and Web of Science). Only full-text research manuscripts published in English between the years of 2000 and 2012 were included. The manuscripts were retrieved based on the following keywords and/or abbreviations: [Stem Cells from Human Exfoliated Deciduous teeth (SHED)] AND/OR [Dental Pulp Stem Cells (DPSC)] AND [tissue regeneration] AND [tissue repair]. Only manuscripts involving in vivo applications of SHED or DPSC for the repair and/or regeneration of non-dental tissues were included. The search strategy produced 2309 papers, from which 14 were eligible according to the predetermined inclusion and exclusion criteria. Although human tissue was the source of cells in half of the studies included in our review, all of the studies involved transplantation into animals of other species, such as pigs, rats and mice. Most of the manuscripts reported the successful use of DPSCs or SHED for non-dental tissue repair or regeneration. While these cell populations represent promising alternative sources of stem cells for tissue engineering and cell-based regenerative medicine therapies, it is not yet possible to guarantee the appropriate clinical management of this technique.

PURPOSE: To analyze the effects of aqueous ozone irrigation over bone healing in hyperglycemia-induced rats. METHODS: Forty-eight male Wistar rats were allocated into Group H (hyperglycemic) or Group N (control). Monocortical bone wound were performed on femurs' anterolateral face. Wounds were treated with a trans-operatory single irrigation of 100ml of aqueous ozone [0.004mg/ml] whereas control groups received 100ml of pure water (Milli-Q®). Histomorphological and histomorphometrical analyses were accomplished after seven, 14 and 21 days. Kruskal-Wallis and Mann-Whitney statistical tests were applied for bone neoformation quantification and assessment. RESULTS: Aqueous ozone wounds irrigated revealed diffuse hemorrhage and increased neoformed of blood vessels number. There was no statistical significant difference in bone trabeculae neoformation. After seven and 14 days, the number of osteoclasts was higher in aqueous ozone groups than in those treated with pure water. CONCLUSION: Independently of blood glucose levels, aqueous ozone allowed an increase in blood vessels neoformation and osteoclast migration, without affect bone trabeculae neoformation.

Os bisfosfonatos (BFs) têm sido indicados para o tratamento de doenças do metabolismo ósseo. Atualmente, seu emprego terapêutico aumentou e, com ele, os efeitos adversos, dos quais um dos mais importantes é a indução da osteonecrose dos maxilares, uma complicação de difíceis tratamento e solução. Até o presente, não se sabe ao certo qual é o mecanismo de desenvolvimento da osteonecrose dos maxilares induzida por bisfosfonatos (ONMB), nem qual deve ser o tratamento estabelecido perante essa manifestação. Apesar de a literatura apresentar formas variadas de tratamento, não existe um protocolo definido. Apresentamos uma revisão sobre a ONMB, enfocando sua etiopatogenia e as formas reportadas de tratamento.

Bisphosphonates (BPs) have been used for the management of bone metabolic diseases. Currently their therapeutic use has increased, as also have their adverse effects, one of the most important being the bisphosphonate-related osteonecrosis of the jaw (BRONJ), a complication of difficult treatment and solution. Until now, the physiopathology of BRONJ remains unclear, and its treatment is uncertain. Although the literature provides several treatment options, there is no defined protocol. We present a review about BRONJ, focusing on its pathogenesis and its reported forms of treatment.

Dentigerous cyst (DC) is one of the most common odontogenic cysts of the jaws and rarely recurs. On the other hand, keratocystic odontogenic tumor (KCOT), formerly known as odontogenic keratocyst (OKC), is considered a benign unicystic or multicystic intraosseous neoplasm and one of the most aggressive odontogenic lesions presenting relatively high recurrence rate and a tendency to invade adjacent tissue. Two cases of these odontogenic lesions occurring in children are presented. They were very similar in clinical and radiographic characteristics, and both were treated by marsupialization. The treatment was chosen in order to preserve the associated permanent teeth with complementary orthodontic treatment to direct eruption of the associated permanent teeth. At 7-years of follow-up, none of the cases showed recurrence.