Medicina Oral Patologia Oral Y Cirugia Bucal最新文献

Background: Autologous fat grafting (AFG) has become increasingly used in reconstructive surgery due to its accessibility, safety, and regenerative potential. In head and neck cancer (HNC) patients, however, concerns remain regarding its oncologic safety, particularly due to the presence of adipose-derived stem cells (ASCs), which may theoretically influence tumor recurrence. This scoping review aims to synthesize current evidence regarding the safety of AFG in this unique patient population.

Material and methods: The review was conducted following the PRISMA-ScR guidelines. PubMed and Scopus databases were searched up to December 2024 using the terms "autologous fat grafting," "lipofilling," "head and neck cancer," and "oncologic safety." Eligible studies included clinical or experimental works reporting on AFG in HNC patients with oncologic outcome assessment. Exclusion criteria included purely aesthetic procedures and studies without relevance to oncologic safety. Data were extracted on study design, patient population, fat grafting technique, follow-up, and reported oncologic outcomes.

Results: Five key studies fulfilled the inclusion criteria: a multinational survey of surgeons (Fiedler et al., 2021), a retrospective cohort study of parotidectomy patients (Boschetti et al., 2023), a narrative review on craniofacial oncologic patients (Drochioi et al., 2019), a retrospective series of 116 patients (190 procedures) (Kamali et al., 2018) and a retrospective cohort with radiation-induced fibrosis (Griffin et al., 2019). Across these works, no evidence of increased recurrence or metastasis following AFG was reported. Favorable functional and aesthetic outcomes were consistently observed, although methodological variability and short follow-up durations limited the robustness of conclusions.

Conclusions: Current evidence suggests that AFG is oncologically safe and beneficial for reconstructive purposes in head and neck cancer patients, improving contour and tissue quality. Nevertheless, the lack of large, prospective, and long-term studies precludes definitive recommendations. Standardized protocols and extended oncologic follow-up are essential to confirm safety and guide future clinical practice.

Background: Oral leukoplakia and proliferative verrucous leukoplakia represent oral potentially malignant disorders. Oral leukoplakia typically presents as solitary lesions, while proliferative verrucous leukoplakia manifests as multifocal lesions with higher malignant potential. This study aimed to investigate the genetic heterogeneity between these disorders through differential gene expression, genetic variants, and microRNA profiling to identify potential biomarkers for diagnosis and prognosis.

Material and methods: Biopsies and peripheral blood samples were obtained from 20 patients. Subsequently, RNA extraction, RNA-Seq libraries preparation, and bioinformatic analyses were conducted to ascertain differential gene expression, genetic variants, and microRNA expression.

Results: In mRNA analysis, overexpressed genes in proliferative verrucous leukoplakia are primarily associated with inflammation and immune regulation, while underexpressed genes relate to skin barrier maintenance. Pathway analysis reveals underexpressed genes related to impaired keratinization in proliferative verrucous leukoplakia and with keratin envelope formation in oral leukoplakia, while overexpressed genes are linked to synaptic processes and protein-protein interactions. Somatic mutation drivers in proliferative verrucous leukoplakia include variants in NRXN3, SRGAP2B, INIP, MYO18A, and ATF7IP genes. Regarding variant analysis, two variants in the Syndecan 3 (SDC3) gene identified in proliferative verrucous leukoplakia have demonstrated enormous value and indicate an important biomarker for a differential diagnosis and to predict prognosis. Proliferative verrucous leukoplakia shows in miRNA analysis MIR1246 and MIR767 overexpression, with MIR135B being the most underexpressed.

Conclusions: Our findings emphasize the intricate transcriptomic profiles in oral leukoplakia and proliferative verrucous leukoplakia development, laying the groundwork for future studies to enhance clinical management and patient outcomes in oral oncology. Syndecan 3 gene polymorphisms may represent a key point in proliferative verrucous leukoplakia differential diagnosis and prognostic prediction.

Background: Accurate virtual planning for orthognathic surgery and dental implants requires integrating cone-beam computed tomography (CBCT) images into digital dental models, but the impact of different scanning methods on the superimposition accuracy remains unclear. The aim of this study was to compare the superimposition accuracy of dental models obtained from two scanning methods using CBCT scans of dental surfaces.

Material and methods: The maxilla (MX) and mandible (MD) of 4 dry skulls were scanned using CBCT and converted into 3D meshes. Dental arches were obtained using intraoral devices (IS) and by digitizing plaster models using an extraoral scanner (PM). Sixty-four digital models were produced per group. Each 3D mesh and corresponding model were imported into the Geomagic software for alignment and deviation analysis. Registration errors and mean deviations (MD+ and MD-) were assessed quantitatively, and the qualitative evaluation was performed through color maps.

Results: Deviations ranged from -0.4 to 0.3mm in both groups, with 80% of the values distributed between -0.5 and 0.5mm. In both groups, Registration error, MD+ and 3D Error were below 0.5mm and MD- was higher than -0.5mm. Statistically significant differences were found between IS and PM models for MD+ as well as for registration error and MD+ in mandibular comparisons.

Conclusions: Superimpositions were not affected by the model acquisition method, and both were clinically acceptable. However, PM superimpositions showed greater deviation magnitudes, suggesting an inclination for IS to produce more accurate alignments, especially in the mandible.

Background: This study aimed to evaluate implants placed in the mandible and maxilla and analyze the correlation between local and systemic factors that affect the clinical and prosthetic performance of short and extra-short implants.

Material and methods: Implants were analyzed based on 18 factors: Location (anterior or posterior; maxilla or mandible); presence or not of previous grafting; bone quality; prosthesis was/was not installed immediately; type of prosthetic connection (external hexagon or Morse Taper); thread type (trapezoidal, triangular, or hybrid); surface's characteristic; implant length; implant width; prosthesis installation follow-up; type of prosthesis retention (cemented or screw-retained); single prosthesis or splinted to another implant; antagonist occlusion type; presence or absence of intermediary prosthetic component; prosthetic abutment height; distance between intermediaries component; presence or absence of implant bicortilization; and implant insertion torque. Clinical intraoral analysis included dimensions of the occlusal part and the inclination of the cusps (≤15 degrees versus >15 degrees). Possible systemic influences were also evaluated. Patient satisfaction was assessed through a questionnaire. The statistical analysis considered results significant if p<0.05.

Results: This study analyzed 91 dental implants (60 short/extra-short and 31 standard/long) placed in 16 patients, including individuals with diabetes (n=3), smoking (n=1), and parafunctional habits (n=7). Implants were distributed across the maxilla (43.3%) and mandible (56.7%) arches, with one short implant failure (survival rate = 98.3%). The mean peri-implant bone loss was 6.80±13.06 mm² for short/extra-short and 8.19±12.10mm² for standard/long implants. Bone loss was lower in males (3.32±6.03mm²) than in females (7.61±8.55mm²), and implant diameter influenced the osseointegration loss area, highlighting relevant biomechanical and risk-related factors. Significantly reduced peri-implant bone loss was observed in implants with abutments >2mm, Morse taper connections, bicorticalization, insertion torque ≤35N, anterior placement, maxillary location, and prior bone grafting (p<0.05 for all). These findings suggest that such variables may positively influence osseointegration and support the long-term success of short implants.

Conclusions: The use of short- and extra-short implants is a feasible treatment option for mid- and long-term rehabilitation of the full and partial maxillary and mandibular arches.

Background: We explored postoperative non-surgical site complications in orthognathic surgery (OS) and investigated associations between outcome and patient- and surgery-related variables.

Material and methods: This single-centre (Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland) retrospective study included patients ≥18 years undergoing OS between January 2016 and December 2022. Data were manually reviewed from the hospital database. Associations with the outcome were analysed using SPSS software (IBM Corporation, 28.0.0.0).

Results: Of 429 patients, 16 (3.7%) had a non-surgical site complication, and a total of 19 complications were recognized. A potentially life-threatening somatic complication occurred in 0.7% of patients. The most common complication was severe psychiatric morbidity, constituting 37% of all recognized complications. In the univariate and multivariable regression model, preoperative long-term disease (aOR 4.729; 95% CI 1.510-14.812; P=.008) and alcohol/substance abuse (P=.027) predicted the outcome independently. No other evaluated variables were associated with the outcome.

Conclusions: The results suggest that severe general complications are rare and are associated with patients' long-term diseases. Severe psychiatric complications comprised a significant proportion of all recognized complications. Attention should be paid to patients' somatic and psychiatric status at all stages of treatment.

Background: Intestinal-type adenocarcinomas (ITACs) most often arise in the sinonasal tract, typically associated with occupational exposures, but they rarely occur in other head and neck sites. When present in extra-sinonasal regions, their clinicopathological and molecular characteristics remain poorly understood. This systematic review aimed to clarify the clinicopathological, immunohistochemical, and molecular features of non-sinonasal intestinal-type adenocarcinomas (ITACs) of the head and neck.

Material and methods: This review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD42022309841). Two reviewers independently screened, extracted data, and assessed risk of bias using the Joanna Briggs Institute tools. Sources included PubMed/MEDLINE, Scopus, Embase, Web of Science, Google Scholar, and OpenGrey. A comprehensive search identified 1,376 records. After applying eligibility criteria, 26 studies comprising 37 cases were included. Data on clinical, histological, immunophenotypic, molecular, and prognostic features were analyzed.

Results: Most patients were male (73%), with a mean age of 57.9 years. The oral cavity, particularly the mobile tongue (51.4%), was the most commonly affected site. Histologically, colonic (59.5%) and mucinous (56.8%) architectures were the most frequent microscopic patterns presented. Immunohistochemistry frequently showed positivity for CK7, CK20, and CDX2, while SATB2, MUC1, and MUC5AC had variable expression. Mismatch repair proteins were intact in all cases. Molecular findings included mutations in MLL3, TP53, EGFR, and AKT1, and upregulation of PAX1, MUC5B, and EMT-related genes, suggesting a distinct profile from sinonasal ITACs. Surgical resection, often with adjuvant therapy, was the main treatment. Tumors were aggressive, with metastases being present in 35.1% and disease-specific mortality in 24.3%.

Conclusions: Non-sinonasal ITACs are rare, aggressive malignancies requiring accurate diagnosis and further molecular investigation to improve management and outcomes.

Background: Patients undergoing treatment with antiplatelet or anticoagulant drugs are attending dental consultations. Therefore, it has become essential to evaluate the patient before treatment and to conduct a thorough medical history. The goal of this study is to analyze the patients attending a dental clinic over a period of 6 months to determine how many are taking antiplatelet or anticoagulant medications, what dental treatment they seek, what hemostatic measures are taken, and whether they suffer hemorrhagic complications as a result of the treatment. This will help to prevent such complications by applying appropriate protocols, especially in the field of oral surgery.

Material and methods:  Over a six-month period, 867 patients attended a dental clinic in Madrid. Of these, 43 were taking antiplatelet agents or anticoagulants. A descriptive statistical analysis was conducted to gather data on age, gender, medication, dental treatment received, and hemorrhagic complications.

Results:  Only 4.9% of the patients attending the dental clinic were taking antiplatelet or anticoagulant medications. Specifically, 53.48% were taking antiplatelet agents, 34.8% were taking direct oral anticoagulants, and 11.62% were on vitamin K antagonist anticoagulants. After applying the appropriate clinical protocol in each case, only one patient experienced postoperative bleeding, which was not severe.

Conclusions:  Based on the results, it may not be necessary to withdraw antiplatelet or anticoagulant therapy due to the low incidence and non-severity of complications in simple dental procedures.

Background: Histopathological parameters significantly impact the prognosis and treatment strategies of oral squamous cell carcinoma (OSCC). Various risk assessment scores and grading systems have been proposed in the past, primarily based on subjective assessment of microscopic features. To modify Brandwein-Gensler risk score by including the worst pattern of invasion-5, perineural invasion and percentage stromal tumor infiltrating lymphocytes(TILs) and evaluate the relationship of the modified score with clinicopathological variables.

Material and methods: This retrospective observational study was conducted on fifty-eight OSCC patients. The density of stromal TILs was determined on routine microscopic sections using image analysis software, thereby quantifying lymphocytic host response as percentage stromal lymphocytes. Furthermore, the modified Brandwein-Gensler risk score was derived from the assessment of the worst pattern of invasion-5, perineural invasion and percentage stromal tumor infiltrating lymphocytes. Chi-square test and Univariate analysis were used to find the association of categorical and continuous variables. The Kaplan-Meier and log-rank tests were used to estimate the survival rates.

Results: A significant positive association of modified Brandwein-Gensler score was observed with pathological node (p=0.005), tumor grading (p=0.025), depth of invasion(p=0.016) and overall survival (p=0.03), signifying that high score tumors showed poor differentiation, invasive features and lower survival time.

Conclusions: A modified, simplified and objective version of Brandwein Gensler histological risk assessment score is derived, revealing a significant association with tumor differentiation, depth of invasion and lymph node involvement.

Background: Up to 50% of patients with inflammatory bowel disease (IBD) have associated oral extraintestinal manifestations (OEIMs). We aim to describe the prevalence of OEIMs in IBD and propose a therapeutic algorithm.

Material and methods: Electronic health records of adult patients with IBD who presented with at least one oral symptom between January 2017 and November 2021 at a tri-state tertiary academic medical center were retrospectively reviewed. Data included demographics, IBD history, oral diagnoses, OEIM treatments, clinical outcomes, and comorbidities.

Results: A total of 116 patients were included; 67 (57.8%) had Crohn's disease (CD) and 49 (42.2%) had ulcerative colitis (UC). Aphthous ulcers were the most common OEIM (80.2%). Frequently used treatments included compounded or mixed mouthwashes (51.7%), topical corticosteroids (33.6%), systemic corticosteroids (20.7%), and topical anesthetics (19.8%). In CD, colchicine was significantly associated with OEIM improvement (p=0.009). In UC, systemic corticosteroids (p=0.03), colchicine (p=0.048), and topical tacrolimus (p=0.048) were significantly associated with improvement.

Conclusions: OEIMs are common in IBD and can influence treatment decisions. Colchicine and topical agents demonstrated benefit in selected cases. These findings support multidisciplinary care and inform a therapeutic algorithm for OEIM management in IBD.

Background: Surgical extraction of third molars is a common oral and maxillo-facial surgery procedure frequently associated with postoperative complications, such as pain, swelling, and trismus. Photobiomodulation (PBM), also known as Low-Level Laser Therapy (LLLT), involves the use of low-intensity laser to promote tissue healing, reduce inflammation, and relieve pain. This study evaluated the effectiveness of PBM following surgical extraction of mandibular third molars.

Material and methods: This was a prospective, multicenter, randomized, triple-blind clinical trial conducted across five Italian centers. Seventy-nine patients were randomly assigned to a test group (PBM) or control group (no PBM). PBM was delivered immediately after surgery and on the following two days, using a multiband diode laser (445, 660, and 970nm). Primary outcomes were postoperative pain, facial swelling, and trismus. Secondary outcomes included health-related quality of life and analgesic consumption. Covariates included patient age, gender, the extracted tooth and the impaction classification according to Pell & Gregory and Winter. The time of the surgical procedure, measured in seconds from incision to final suture, was also documented. Descriptive statistics were calculated for all variables. Normality was assessed using the Shapiro-Wilk test, and homogeneity of variances was evaluated using Levene's test. Between-group comparisons for continuous outcomes were performed using Student's t-test or the Mann-Whitney U test, depending on data distribution. Categorical variables were analyzed with chi-square or Fisher's exact test. A p-value< 0.05 was considered statistically significant.

Results: No statistically significant differences were found between groups for any of the measured outcomes. However, trends favored the PBM group, particularly regarding reduced pain and improved quality of life.

Conclusions: The study was powered to detect a large effect size (Cohen's d=0.8); therefore, the lack of statistical significance suggests that any true effect, if present, is likely smaller than this threshold. Further studies with larger sample sizes and standardized protocols are needed to explore smaller yet clinically relevant effects.