Medicina Oral Patologia Oral Y Cirugia Bucal最新文献

Background: Oral squamous cell carcinoma (OSCC) is an aggressive cancer, with prognosis influenced by clinical variables as well grading systems and perineural invasion (PNI), which are associated to poorer outcomes, including higher rates of recurrence and metastasis. This study aims to evaluate OSCC using three grading systems and assess the impact of PNI and clinicopathologic parameters on patient survival.

Material and methods: Eighty-one primary OSCC samples were analyzed. Histopathological evaluations were performed utilizing Malignancy Grading of the Deep Invasive Margins, WHO grading system, and the Histologic Risk Assessment. S-100 immunohistochemistry was used to detect PNI. Five-year disease-specific survival (DSS) curves were generated using the Kaplan-Meier method, and the Cox proportional hazards model analyzed prognostic significance.

Results: Advanced clinical stage was significantly associated with reduced survival (p-value <0.001, HR = 4.07). Patients without regional lymph node involvement had better survival (p-value 0.002, HR = 0.37). Higher histologic risk assessment scores were linked to worse outcomes. Multifocal neural invasion significantly correlated with poorer survival compared to unifocal invasion (p-value 0.017, HR = 4.20). Patients undergoing surgery followed by adjuvant therapies had better survival rates.

Conclusions: Besides clinical stage and histological grade, PNI also showed to be a crucial prognostic factor in OSCC, necessitating aggressive treatment strategies.

Background: The preservation of the alveolar ridge following tooth extraction is crucial to prevent atrophy and maintain structural integrity, facilitating future dental rehabilitations. This study compared the use of two different polymeric, resorbable membranes: polylactic acid (PLA), and 5% polylactic acid + 95% polycaprolactone (PLA/PCL), relative to unassisted socket healing (negative control).

Material and methods: A preclinical model involving healthy, skeletally mature beagles (n=7) were used in this study. Surface topography and thermal degradation of the membranes were assessed, followed by in vivo evaluation of socket preservation in extracted maxillary premolars. Histomorphometric analysis was employed to measure bone formation and total socket area. Data was analyzed through linear mixed models with fixed factor of treatment following a post-hoc comparison by the Tukey test. Ranked data of residual membrane presence and inflammatory infiltrate were analyzed through Kruskal-Wallis non-parametric test. All analyses were conducted with statistical significance set at p-value ≤ 0.05.

Results: Surface topography depicted a distinctive fibrous network structure for PLA membrane relative to PLA/PCL which exhibited a more porous architecture. Thermal degradation behavior/profile, observed through TGA and DSC, for both membranes was similar. Histomorphometric analysis of bone formation within the induced socket yielded 36.1 ±7.7%, 35.6 ±7.2% and 32.8 ±7.7% for control, PLA and PLA/PCL groups, respectively, with no statistically significant differences between groups (p = 0.796). Analysis of total socket area (mean ± 95% confidence intervals) yielded significantly higher values for experimental groups, PLA (8.95 ± 1.7 mm2) and PLA/PCL (8.8 ± 1.76 mm2), relative to control (6.7 ± 1.8 mm2) (p = 0.041). Residual membrane, along with mild inflammatory infiltrate was observed after the healing period irrespective of membrane type utilized.

Conclusions: Guided bone regeneration (GBR) with PLA and PLA/PCL membranes did not yield higher bone formation within the socket relative to the control group. However, an improvement in the preservation of the socket's architecture was observed.

Background: The study aimed to investigate the effect of customized lateral nasal wall osteotomy (LNO) on the lateral nasal wall (LNW) and pterygomaxillary junction (PMJ) separation during Le Fort I. We hypothesized that customized LNO on the LNW affect the PMJ separation type.

Material and methods: This prospective, controlled, randomized study included forty-three patients were randomly assigned to either the conventional or customized (study) osteotomy groups. In the study group, LNW depth was measured before surgery in the axial section of the CT scan, and LNO was performed at a depth of 2 mm less than the measured distance. In the conventional osteotomy group, LNO was performed at 30 mm for females and 35 mm for males. Patients with cleft lip and palate, previous orthognathic surgery, or rhinoplasty were excluded. Separation types were classified as follows: LNW types; Type1-from the osteotomy line; Type2- 2-4 mm above the osteotomy line; Type3- 4 mm or more above the osteotomy line. PMJ types; Type1-including the tuber maxilla; Type2-from the pterygomaxillary junction; Type3-including the pterygoid plates. Chi-square tests were conducted to determine whether there was a significant correlation between groups and LNW separation types, groups and PMJ separation types and groups, and LNW separation type and PMJ separation type. A P value of < .05 was considered statistically significant.

Results: In both the conventional (P=0.052) and the study groups (p=0.828), there was no significant difference between LNW depth. Type 1 (P=0.0003) and Type 2 (P=0.0051) LNW separation types presented a significant difference between groups. A chi-square test showed a significant correlation between the surgical groups and PMJ separation patterns (P<0.05).

Conclusions: Customized LNO optimizes the LNW and PMJ separation. Facilitates the Le Fort I surgery and decrease unintentional fracture of the PMJ.

Background: Transverse maxillary deficiency is a relatively common type of malocclusion, that if left untreated will probably affect the permanent dentition. Recent investigations have proposed the use of bone-supported miniscrews around the midpalatal suture to expand the palate in late adolescents. The aim of this systematic review was to assess the efficacy of the Miniscrew Assisted Rapid Palatal Expansion (MARPE) technique in young adult patients, by quantifying skeletal expansion in relation to the age of the patient, as well as the impact upon other craniofacial sutures, and to describe the possible dental side effects.

Material and methods: An electronic and manual search was conducted, in which 17 were included in the study.

Results: The estimated mean palatal opening width and nasal cavity width was 2.99 ± 0.33 mm and 2.24 ± 0.17 mm, respectively. A significant association was observed between midpalatal and pterygoid suture opening (p=0.010). No association was found between age and the MARPE technique (p=0.701).

Conclusions: The results of this study show that the MARPE technique produces significant opening width in young adults at both at midpalatal suture and nasal cavity level, and apparently only significantly widens the pterygoid suture. Greater dental side effects are directly associated to a reduced midpalatal suture opening width.

Background: This study aims to compare scalpel and diode laser techniques regarding patients' perceptions, tissue healing, diastema, and periodontal clinical parameters in the treatment of abnormal labial frenum.

Material and methods: This prospective, randomized, controlled trial evaluated 43 patients (aged 18-55) requiring labial frenectomy, randomized to scalpel or diode laser therapy. Plaque index (PI) and gingival index (GI) were measured at baseline, 4 weeks, and 6 months post-surgery. Keratinized gingiva width (KGW) of maxillary central incisors and diastemas were measured at baseline and 6 months post-surgery. Postoperative pain was evaluated on days 1, 7, 14, 21, and 28 using a visual analog scale. Wound healing was assessed at 7 days and 4 weeks postoperatively, scored based on the degree of epithelialization and the presence of ulceration or necrosis.

Results: At 6 months, both groups showed a significant reduction in PI, GI, and diastema (P<0.05). KGW increased in both groups, with a significant increase in the laser group (P<0.05), though baseline and 6-month KGW values were not significantly different between groups: baseline values were 5.30 ± 1.396 for the scalpel group and 5.05 ± 1.276 for the laser group, and 6-month values were 5.65 ± 1.152 for the scalpel group and 5.50 ± 1.147 for the laser group (P<0.05). The diode laser group had significantly lower pain scores than scalpel group on days 1, 3, and 7 (P<0.05). however, from day 14 onward, there was no statistically significant difference in pain scores between groups (P<0.05). Tissue healing was significantly faster on day 7 in the scalpel group (P<0.05).

Conclusions: Frenectomy with diode laser effectively reduces pain, although it may delay wound healing. Laser therapy serves as a feasible alternative to the scalpel method. However, further research is necessary to fully assess its benefits and limitations in soft tissue procedures.

Background:  Craniofacial mucormycosis is a highly lethal infectious disease. This study aims to assess and analyze multiple variables, including clinical, socioeconomic, and biochemical markers, to identify and examine risk factors for mortality associated with this mycotic infection.

Material and methods:  A retrospective analysis was conducted on 38 patients who sought medical attention at the Otolaryngology and Head and Neck Surgery Division of a tertiary-level hospital in Monterrey, Mexico. A broad range of variables was analyzed: clinical features, including the extent of mucormycosis infection; socioeconomic factors such as monthly income, marital status, geographical residence, educational level, and insurance status; as well as biochemical markers, including glucose levels, lactate dehydrogenase (LDH), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and immune cell counts, specifically neutrophils (NEU) and lymphocytes (LYM). Statistical analysis was conducted using SPSS v26. Risk factors for mortality were evaluated using Cox regression. Overall survival (OS) was assessed with the Kaplan-Meier method. The Fisher's exact test and the Chi-square test were used for categorical variables. For median comparisons, the Student's t-test and Mann-Whitney U test were applied; with normality assessed using the Shapiro-Wilk test. A p-value <0.05 was considered statistically significant.

Results:  Mucormycosis was associated with higher mortality in men (p=0.032). The disease primarily affected the paranasal sinuses (p=0.021) and was associated with increased mortality when involving the orbit (p=0.035). Additionally, compromised lymphocyte counts (LYM) (p=0.034) and lower educational levels (p=0.009) were associated with higher mortality. Individuals residing in rural areas also exhibited an elevated risk of mortality (p =0.023).

Conclusions:  Prevention strategies should focus on high-risk groups to reduce the mortality rate of craniofacial mucormycosis, particularly targeting men and individuals residing in rural areas. Special emphasis should be placed on those without education or health insurance. Early diagnosis and appropriate management are crucial for improving outcomes.

Background: Primary Sjögren Syndrome (pSS) is an autoimmune disease that usually affects salivary glands. Research about the impact of oral health in quality of life of patients with pSS is scarce.

Objectives: to describe the characteristics of oral involvement in patients with pSS; To assess quality of life related to oral health (QOL-OH); to determine association between QOL-OH and saliva production, disease activity, and damage.

Material and methods: An observational, analytical and cross-sectional study was conducted. Patients aged ≥18 years with pSS were included. Primary outcome was assessed by the Oral Health Impact Profile (OHIP14sp). The EULAR Sjogren's Syndrome Patient Reported Index (ESSPRI), the EULAR Sjögren's syndrome Disease Activity Index (ESSDAI), the Sjogren's Syndrome Damage Index (SSDI) and a Visual Analogue Scale (VAS) for xerostomia, were performed. A dentist evaluated the Decayed, Missing, and Filled Permanent Teeth index (DMFT), O'Leary index (OLI) and Loe & Silnes index (LSI). A multiple linear regression model was performed, taking OHIP14sp as the dependent variable.

Results: 51 patients were included. Mean age 54 (±13 years). The OHIP-14sp median was 16 [6-25], xerostomia VAS median was 60 [30-80]. Mean of ESSPRI: 4 (± 2.6), ESSDAI median: 0 [0-2], SSDDI median: 3 [2-4]. Oral involvement occurred in 100% of patients, DMFT median: 22 [14-28], OLI median: 21[13-30]. In the univariate analysis, OHIP14sp was significantly associated with ESSPRI (β2 95%CI 0.72-3.3), xerostomia VAS (β0.19 95%CI 0.08-0.29) and category 2 of the LSI (β: 18 95% CI: 5-31). In the multivariate analysis, OHIP14sp was independently and significantly associated with xerostomia VAS (β0.19 95%CI 0.09-0.29) and category 2 of LSI (β19 95% CI: 7.7-29.7).

Conclusions: These findings demonstrate the effects of xerostomia on daily life of patients influencing not only their oral health but also their quality of life.

Background: Removal of third molars often leads to complications such as pain, swelling, and trismus, impacting patient quality of life. Various strategies including cryotherapy, different suture techniques, and chlorhexidine are employed to mitigate these effects. However, the effectiveness of these interventions is still debated, as clinical trials present inconsistent and contrasting results. This study aims to assess the certainty of evidence from systematic reviews and meta-analyses regarding the effects of these interventions on clinical outcomes and patient quality of life following third molar surgery.

Material and methods: This evidence mapping followed the Global Evidence Mapping Initiative and PRISMA guidelines, utilizing databases such as PubMed, Embase, Cochrane, Web of Science, and Google Scholar until February 2024. Methodological quality was assessed via AMSTAR-2 and the effects of these interventions on outcomes of interest were classified as "beneficial", "probably beneficial", "harmful", "no effect", or "inconclusive". Findings were mapped using the PyMeta platform.

Results: Thirteen studies were reviewed. All systematic reviews evaluated the effects of these interventions on clinical outcomes following third molar surgery, but none assessed the impact on patient quality of life. Cryotherapy was classified as probably beneficial for reducing pain and swelling within the first 72 hours post-surgery. Secondary surgical wound closure was effective in reducing pain, swelling, and trismus during the first postoperative week, but it did not mitigate the risk of bleeding, infection, or alveolitis. Chlorhexidine, especially when used as a mouthwash, is effective in preventing postoperative alveolitis. However, most reviews (76.9%) were rated as "critically low" methodological quality.

Conclusions: Although the potential benefits of cryotherapy, secondary surgical wound closure, and chlorhexidine on clinical outcomes, this study revealed a predominantly low quality of evidence from systematic reviews and meta-analyses. Moreover, further research should expand investigations into the patient-centered outcomes to better guide clinical practice.

Background: Third molar extraction surgery is a common procedure, but it results in pain, swelling, and trismus. Ozone therapy (Oz) has emerged as a viable option for pain control and as an option to limit bacterial growth, improving the wound healing. Then, this randomized controlled trial aimed to evaluate the effectiveness of adjunctive use of ozone therapy (OzT) in managing pain, swelling, and trismus after lower third molar removal.

Material and methods: A split-mouth design was selected, enrolling 60 patients. There were 2 groups (Sham and OzT). The same surgeon performed all procedures. The pain was evaluated using the VAS scale and the number of paracetamol tablets taken. The quality of life was assessed using the OHIP-14 questionnaire. The data were statistically evaluated.

Results: 120 surgical procedures were performed on 60 participants (34 males [56%] and 26 females [44%]). Regarding the number of paracetamol tablets taken, the test group had a significantly lower consumption (p<0.002). In addition, the test group presented a significantly lower pain score on days 1, 3, and 5 postoperatively, with no difference between groups on the 7th day (p<0.0145). Both sides presented postoperative edema, which regressed from day 5 (no significant difference). A similar case scenario was observed for mouth opening. OzT impacted the patient's quality of life (OHIP-14, p<0.05), favoring ozone therapy.

Conclusions: The results demonstrated that OzT is an effective adjunctive strategy for reducing postoperative pain following the extraction of lower third molar teeth.

Background: Growing evidence suggests that prediabetes may increase the risk of periodontitis, though the extent of this association remains unclear. To provide a clearer understanding, this meta-analysis focused on observational studies that utilized multivariate analyses to adjust for key confounding factors.

Material and methods: A comprehensive search of PubMed, Embase, and Web of Science was conducted to identify observational studies assessing the relationship between prediabetes and periodontitis. Only studies that utilized multivariate analyses were included to minimize confounding bias. The quality of the studies was evaluated with the Newcastle-Ottawa Scale (NOS). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model, with heterogeneity assessed by the I² statistic.

Results: Ten observational studies with 38,727 participants were included. Overall, individuals with prediabetes had a significantly higher risk of periodontitis compared to normoglycemic individuals (OR: 1.27, 95% CI: 1.09 to 1.48, p < 0.001) with moderate heterogeneity (I² = 53%). Subgroup analyses revealed a stronger association in studies where the proportion of men was < 45% compared to those ≥ 45% (OR: 1.75 vs. 1.15, p for subgroup difference = 0.01). Studies with lower quality (NOS score = 7) showed a stronger association compared to higher-quality studies (NOS score = 8 or 9, p for subgroup difference = 0.003).

Conclusion: This meta-analysis found that prediabetes may be independently associated with an increased risk of periodontitis. Further research is needed to explore the mechanisms underlying this association and potential sex-specific effects.