Medicina Oral Patologia Oral Y Cirugia Bucal最新文献

Background: Oral cancer and oral potentially malignant disorders (leukoplakia and oral submucous fibrosis) are prevalent and clinically significant oral diseases. Actin, crucial for epithelial tissue integrity, undergoes cytoskeleton reorganization associated with increased invasiveness in oral cancer.

Material and methods: Bioinformatic analysis of RNA-seq data from GEO public databases was performed to detect differentially expressed genes in oral cancer, leukoplakia and oral submucous fibrosis. Enrichment analysis of the differentially expressed genes was performed using DAVID and GSEA software. ROC curve and survival analysis were conducted to assess the discriminative capacity of these genes as possible biomarkers. The results were further validated using RNAseq data from The Cancer Genome Atlas (TCGA).

Results: EPRS1 was consistently overexpressed in all three pathologies. Key genes (ACTIN1, LIMK1, CORO1C, INF2, SH3D21, CFL1, FSCN1, MYO1B) implicated in actin cytoskeleton organization were identified, suggesting their role in oral potentially malignant disorders and cancer progression. Receiver operating characteristic (ROC) curves on 522 TCGA samples demonstrated these genes' potential as early biomarkers for oral cancer, with their inhibition associated with improved survival.

Conclusions: The identified genes offer insights into actin-related mechanisms and potential pathways for the diagnosis and treatment of oral cancer. Nonetheless, further research is essential to validate these results.

Background: Mesiodens are the most prevalent supernumerary teeth, defined as a dentition anomaly. Mesiodens account for 80% of all supernumerary teeth, with a prevalence in the general population of 0.15% -1.9%. Mesiodens show a higher frequency in man than in women, it is usually found in the front upper jaw, between the midlines of maxillary central teeth. It may be normally oriented or have inverted and transverse orientation. Single or multiple mesiodens may occur; however, double mesiodens is rarer (10-19% of all patients with mesiodens), and even rarer is its double inversion, with the crown and root oriented towards the nasal and oral cavities. The aim of this study is to investigate the main cone-beam computed tomography (CBCT) radiological features of patients affected by mesiodens. Two cases of double mesiodens, one of which with double inversion, in pediatric patients are reported.

Material and methods: According to PRISMA guidelines, a systematic review search was conducted on PubMed, Scopus, and Web of Science. Observational studies conducted on patients with double mesiodens were selected and analyzed, including both radiological features and clinical characteristics. Furthermore, two cases of patients with double mesiodens were reported.

Results: Fourteen studies were included, and 14 patients affected by double mesiodens were analyzed (12 males, 2 females, with a mean age of 13.5 ± 6.4 years).

Conclusions: The present study underscores the importance of considering the CBCT a fundamental investigation to define and appropriate diagnosis and management, and to avoid complications related to a late diagnosis and/or an unnecessary surgical approach.

Background: Over the past decades, the literature has described epidemiological changes in oral cancer. However, few updated studies specifically address this issue, particularly those examining it separately from pharyngeal cancer. Some authors suggest gingival cancer is the only intraoral cancer with a higher prevalence among women.

Material and methods: A retrospective longitudinal study was conducted using the Specialized Care Activity Registry from the Minimum Basic Data Set to obtain data on gingival cancer patients in Spain from 2001 to 2022.

Results: Data from 5,749 patients showed 51.8% were men and 48.2% women. A final predominance in women was observed. The average recorded age was 68.3 years, increasing in both sexes over time. A low frequency of tobacco and alcohol consumption was noted. The age-adjusted incidence was 0.61, with a convergence between sexes due to increased female incidence.

Conclusions: During the study period, a reversal in the male-to-female ratio was observed, along with an increase in recorded age, a preference for the mandible over the maxilla, low tobacco and alcohol consumption, and incidence convergence between sexes due to rising female cases.

Background: Orthognathic surgery is a complex invasive procedure associated with common postoperative symptoms and patient-related events. Dexmedetomidine is an emerging sedative and hypotensive agent that has demonstrated safety and efficacy in perioperative care of other craniofacial procedures.

Material and methods: An electronic search was performed in seven primary databases (Cochrane Library, Embase, LILACS, MedLine via PubMed, SciELO, Scopus, and Web of Science) and one additional (EASY) to partially capture the gray literature. The PICO strategy was used to identify randomized clinical trials evaluating the effect of dexmedetomidine on perioperative events in patients undergoing orthognathic surgery compared to placebo or control groups, without restrictions on publication language and year. Two independent reviewers performed data extraction and assessed the risk of bias using the RoB 2.0 tool.

Results: The search identified 401 records, of which six studies met the eligibility criteria, including 282 patients from five countries, and published between 2008 and 2023. Outcomes were categorized into six groups based on available data: 1) Airway and Respiratory Events, 2) Emetic Events, 3) Hemodynamic Events, 4) Length of Hospital Stay, 5) Neurological Events, and 6) Pain Burden. Dexmedetomidine reduced coughing and maintained hemodynamic stability but did not prevent emergence agitation. It was associated with lower intraoperative fentanyl use and reduced rescue analgesia requirements. Postoperatively, dexmedetomidine effectively controlled pain, nausea, and vomiting, with significantly lower pain scores and reduced analgesic demand. Among the six studies, only one was classified as high risk of bias due to issues in the randomization process, while the others were categorized as low risk of bias. A meta-analysis was planned but could not be conducted due to high heterogeneity among studies.

Conclusions: Dexmedetomidine appears to be a safe and effective option for reducing postoperative symptoms such as pain, nausea, vomiting, and cough in orthognathic surgery, while maintaining hemodynamic stability.

Background: The Basque Country (Spain) is one of the European regions with the highest incidence of oral and oropharyngeal cancer, which still shows an unacceptably poor prognosis. The aim of this study was to update the epidemiological and prognostic data on oral cancer in the Basque Country and to analyse its evolution with respect to a previous study carried out in 1986-1994.

Material and methods: This retrospective study included all cases diagnosed with oral and oropharyngeal cancer in the Basque Country from 2012 to 2017, obtained from the Cancer Population Registry. Descriptive analysis of the epidemiological data on oral-oropharyngeal cancer and survival analysis of oral squamous cell carcinoma were performed.

Results: A total of 1,762 cases of oral-oropharyngeal cancer were analysed. The crude incidence was 7.21 cases in women and 18.07 in men. We recognised an increase in females, older patients and gingival neoplasms. Squamous cell carcinomas accounted for 92.6% of the tumours, with 70.4% affecting males, 91.8% living in urban areas, and 50.2% diagnosed at advanced stages. The overall 5-year survival rate for oral-oropharyngeal cancer in the Basque Country was 50.2%.

Conclusions: Oral and oropharyngeal cancer incidence in the Basque Country has decreased overall, although it shows a progressive increase in women, older people and tumours located in the gingiva. The prognosis of oral cancer in the Basque Country is still very poor, thus it is necessary to implement specific preventive and diagnostic protocols to improve it.

Background: Methods for creating bioengineered replacement teeth benefit from a detailed understanding of the molecular signaling networks that regulate the development of natural teeth. In oral and craniofacial research, spheroid cultures have been explored, various studies on organoids, such as those of salivary glands, taste buds, and teeth, are being conducted. The aim of this review is to provide a comprehensive overview of the current knowledge on dental regeneration.

Material and methods: This review was registered in PROSPERO (CRD 646053) ad performed following PRISMA guidelines. An electronic search was conducted following the PICO question "In animals (P) subjected to bioengineering techniques (I), is successful dental regeneration achieved (O)?" For evaluating risk of bias, the Arrive scale and the JBI adapted for Quasi-experimental studies tools were used.

Results: A total of 83 articles on dental regeneration from the past 5 years were reviewed, and 4 articles that met the selection criteria were included. The studies describe complete dental regeneration in animal models by stimulating genes such as Wnt10a, Bmp6, Grem2a and the identification of genes and antibodies influencing BMP and Wnt signaling pathways (Sox-2), as well as the expression of key factors such as FGF.

Conclusions: The development of signaling pathways in dental formation has advanced, yet many uncertainties persist, particularly in the regeneration of complete teeth. Despite progress with animal models and genetic editing, identifying suitable cellular sources and understanding the key genes involved remain essential for future clinical applications.

Background: The aim of the study was to compare and evaluate the effects of two different kinesio tape techniques on pain, swelling and trismus after mandibular impacted third molar surgery.

Material and methods: This study was designed as a controlled, randomized, prospective clinical trial. Mandibular third molars classified as Class II Position B according to Pell and Gregory classification and as mesioangular position according to Winter's classification were extracted. Patients divided into three groups. After third molar surgery, the classical kinesio tape technique (Technique A- kinesio tape which was divided into three equal segments extending from the cheek region to the clavicle) was applied to the patients in Group 1, while new technique (Technique B- both the classical KT extending from the cheek to the clavicle and an additional Y-shaped KT supporting the masseter muscle) was applied to patients in Group 2. No kinesio tape was placed to the patients in Group 3 during the postoperative period. Antibiotic, analgesic and a mouthwash were prescribed to all three groups. Pain was evaluated using with visial analog scale for 7 days postoperatively. Swelling was assessed on the 2nd and 7th postoperative days by taking measurements from five different points using a paper ruler. Maximum mouth opening was recorded using a caliper postoperatively on the second and seventh days.

Results: Ninety patients (54 female, 36 male) were included in the study. Pain levels in Group 1 and Group 2 were statistically lower compared to Group 3. Statistical differences were found only on the 2nd and 3rd days between Group 1 and Group 2. The lowest pain level was observed in Group 2. Patients in Group 2 required the least amount of analgesics. Swelling in Group 1 and Group 2 was statistically lower than in Group 3. Statistically significant increases in mouth opening were observed in Group 1 and Group 2 compared to Group 3. No signs of infection were observed in the patients. The results of the quality of life scale indicated that patient satisfaction was highest in Group 2.

Conclusions: Although kinesio tape applied with both different techniques was effective in reducing postoperative morbidity, Technique B was more effective.

Background: Dental caries remains one of the most widespread non-communicable diseases. Saliva is crucial for maintaining oral health as it shields teeth from demineralization and promotes the remineralization of enamel. Although ongoing studies are investigating the relationship between various salivary proteins and dental caries, consensus in existing literature has not yet been established. This study aims to provide additional insights into the current research of salivary protein biomarkers association with dental caries.

Material and methods: This systematic review analyzed literature published between January 2013 to December 2023, retrieved from PubMed, Scopus, and Web of Science.

Results: The review included 21 observational studies (2 cohort, 2 case-control, and 17 cross-sectional) involving over 2,000 participants, examining 18 different proteins. There was considerable variability in the types of salivary markers studied. Among the participants, 54% were diagnosed as caries-active (CA), while 45.9% were caries-free (CF), with ages ranging from 6 to 89 years. The Newcastle-Ottawa Scale indicated that the risk of bias was low in 10 studies, intermediate in 10, and high in 1.

Conclusions: Eighteen studies found significant differences in protein expression between CA and CF subjects, underscoring the potential of using salivary biomarkers for non-invasive diagnose assessment. However, larger and greater designed studies are needed to establish their clinical value. Besides, divergent results from proteomic studies on biomarkers may be due to variations in genetics, diet, oral hygiene, age and other factors of the subjects, which could affect the reliability of saliva biomarkers in caries screening and detection. The significant heterogeneity among studies made conducting a proper meta-analysis infeasible.

Introduction: Medication-related osteonecrosis of the jaws (MRONJ) is a serious condition associated with bone modifying agents (BMAs) intake, leading to impaired bone healing and increased morbidity. Despite various therapeutic approaches, an optimal treatment strategy remains elusive. Leukocyte- and Platelet- Rich fibrin (L-PRF) has emerged as a promising autologous biomaterial due to its regenerative properties. This study aimed to evaluate the efficacy of L-PRF in the treatment and prevention of MRONJ.

Material and methods: A prospective cohort study was conducted, including a total of 30 patients diagnosed with MRONJ (stage I or II) or at risk of developing it (non-MRONJ). Patient underwent standardized treatment involving surgical debridement followed by L-PRF application. Clinical and demographic data were collected, and healing outcomes were assessed at multiple follow-up intervals (7 days, 14 days, 1 month, 3 months and 6 months). Statistical analyses, including Kaplan-Meier survival estimates, were performed to evaluate treatment effectiveness.

Results: The study demonstrated an overall healing of 90%, with a complete recovery in 82.4% of confirmed MRONJ cases and 100% of at-risk patients. L-PRF exhibited good clinical outcomes, including reduced inflammation and pain, accelerated epithelialization, and improved tissue regeneration. The median healing time was estimated at 33.41 days for MRONJ patients and 11.00 for non-MRONJ. No significant differences in healing rates were observed based on age, sex, or systemic conditions.

Conclusions: L-PRF represents a promising adjunct in MRONJ management, improving healing outcomes and postoperative recovery. Its autologous nature and growth factor release enhance bone regeneration, suggesting its potential as both a therapeutic and preventive strategy. Further larger-scale clinical trials are needed to standardize protocols and validate long-term efficacy.

Background: The objective of this work is to identify the effectiveness and summarize the scientific evidence of zygomatic implants using the externalized technique, as well as to evaluate the possible complications associated with this technique.

Material and methods: The study was registered in PROSPERO (CRD42022330060) and the searches were carried out in 6 databases (PubMed, Cochrane, LILACS, Scopus, Embase and Google Scholar), by two researchers individually. The aggregated data were subjected to statistical analysis using the MedCalc program for the variables: success rate and frequency of complications, using a 95% confidence interval. The risk of bias of the included studies was determined using the Newcastle-Ottawa Scale (NOS) tool.

Results: 912 articles were found in the initial search and 15 of them were included in this systematic review. A total of 1555 zygomatic implants and 1865 conventional implants were part of the study, with an overall success rate of 96.7% for zygomatic implants and 97.9% for conventional implants. There was no statistically significant difference between the survival of zygomatic implants using the externalized technique when compared with conventional implants (p=0.015). There was no significant heterogeneity between studies (p=0.89, I²=0%). Regarding complications, the most prevalent were sinusitis, which showed a proportion of 3.028% (CI95% = 1.053, 5.980%) and infections, which showed a proportion of 1.56% (CI95% = 0.358, 3.590%). Only three articles included presented a low risk of bias.

Conclusions: Based on the present systematic review and with limited evidence, the use of zygomatic implants using the externalized technique proved to have a high implant success rate and few associated complications for the treatment of atrophic maxillae.