Medicina Oral Patologia Oral Y Cirugia Bucal最新文献

Background: Oral leukoplakia is the most frequent and representative potentially malignant disorder of what is known as oral precancer. Since the first descriptions, this pathology, which initially seems simple, has been the subject of controversy and discussion, and it still maintains multiple unknowns and enigmas to be solved.

Material and methods: A narrative and integrative review of the epidemiological, pathogenetic, diagnostic, prognostic and therapeutic aspects of this important oral disorder has been carried out.

Results: Oral leukoplakia still presents multiple enigmas regarding its actual epidemiology, its multifactorial and multistage pathogenesis, its definition and diagnosis, its malignant development and its treatment.

Conclusions: We must conduct well-designed prospective studies on this fascinating oral pathology, on well-diagnosed clinical cases with clinicopathological criteria agreed and accepted by the scientific community. Only in this way will we be able to clarify the enigmas it still presents.

Background: After lower third molar surgery, suppurative infections can occur. They can spread into adjacent tissues, toward superficial mucosal or skin planes or toward deep facial and neck fascial spaces.

Material and methods: The 2020 PRISMA guidelines for systematic reviews were followed. A literature search was conducted, without initial time limit, in the Medline database, via Pubmed (MEDLINE), and SCOPUS. For the analysis of statistical significance, the hypothesis test on the difference between means with unknown variances was used.

Results: Eleven articles met the inclusion criteria. The total number of extractions taken from the articles included in the review is 7363, with a 5.35% total incidence of purulent infections. The incidence of purulent infections was found significantly higher in cases in which antibiotic prophylaxis was not performed.

Conclusions: Although lower third molar extraction is the most frequently performed oral surgical procedure, little has been written about post-operative purulent infections, in relation to risk factors, involved spaces, and performed therapies, so to be able to identify preventive and therapeutic behaviors based on scientific evidence. Antibiotic prophylaxis is the only variable which resulted in determining a significative statistical reduction in the incidence of purulent infection after lower third molar surgery.

Background: To evaluate dental treatment approaches under general anesthesia in children with cancer.

Material and methods: DMF-T values of existing decay, missing and filled teeth of 68 pediatric patients receiving active cancer treatment were recorded. Systemic and physical examinations of patients were performed by a paediatrician. İntraoral and extraoral examinations of children were performed by pediatric dentists. The dental treatment plan encompasses the child's individualized oral health needs. Dental procedures are generally performed in the controlled environment of a hospital operating room under general anaesthesia. Analyzes were made with SPSS 25.0 package program.

Results: The study determined that the average age was 6.47±2.93. In this study, extraction-focused treatments were used instead of restorative (r=0.346, p=0.01) and endodontic treatments (r=0.274, p=0.01).

Conclusions: Despite the development of restorative and endodontic treatments under general anaesthesia, even pediatric crown applications, radical decisions must be made to control the medical condition of patients with childhood cancers.

Background: Behçet's Syndrome (BS) is a multisystemic vasculitis characterized by a heterogeneous clinical profile, including mucocutaneous, musculoskeletal, neurological, ocular, vascular and gastrointestinal manifestations. BS patients often experience a continuous, low-level disease activity state due to persistent oral ulcers. This study aimed to define relations among oral ulcer activity (OUA), gender and treatments through K-Means Cluster and Correspondence Analyses (CA) in patients with BS.

Material and methods: In this cross-sectional study, 526 BS patients from two tertiary centres in Turkey and the United Kingdom were included. The K-Means Cluster Analysis was performed to identify homogeneous clinical profiles for OUA by combining the disease severity score reflecting organ involvement and the number of oral ulcers. Then, CA was performed to visualize associations between gender and medications (non-immunosuppressive: non-IS vs. IS) in clusters.

Results: K-Means Analysis identified three clusters regarding mucocutaneous and major organ involvement and cluster regarding with major organ involvement. Clusters were named according to OUA and the disease severity. The number of oral ulcers was found to be similar in the "Low OUA" cluster (n=202, 65.03%; 2.18±1.13) and the "Low OUA with Major Organ Involvement" cluster (n=63, 19.25%; 2.19±1.37) (p=0.368). These were lower than those in the "Moderate OUA" Cluster (n=30, 9.8%; 7.60±1.88) and the "High OUA" cluster (n=11, 3.59%; 14.91±2.34) (p<0.001). CA visualized that non-ISs in "Low OUA" cluster, ISs in "Low OUA with Major Organ" cluster for both genders as well as male patients treated with non-ISs or ISs in "Moderate OUA" cluster were predominant groups.

Conclusions: The presence of two oral ulcers might be accepted as the cut-off value for low OUA. Moreover, intensive treatment protocols must be provided for elevated oral ulcer activity in male patients who were treated with non-IS medications in BS.

Background: Oral Pathology (OP) is an important part of diagnosing and managing oral and maxillofacial diseases. Despite being recognized as a specialty in Brazil for over 50 years, significant gaps remain in the availability of specialists and training programs. Therefore, this study aims to map and analyze the training of specialists in OP in Brazil.

Material and methods: A cross-sectional study was conducted using publicly available data from Brazilian governmental databases, including the Federal Council of Dentistry, the Brazilian Institute of Geography and Statistics, and the Ministry of Education. Variables analyzed included the number of OP specialists, their geographic distribution, training opportunities, and population coverage. Descriptive and comparative analyses were performed using Microsoft® Excel (version 2410) and Statistical Package for Social Sciences® (version 27.0).

Results: In 2024, 424 active OP specialists were registered in Brazil, composed of 240 women and 184 men, representing only 0.3% of all dental specialists. The ratio of OP specialists to inhabitants was 1:478,964, with marked regional disparities. The Southeast had the highest density, while the North had the lowest, with some states lacking any OP specialists. Additionally, 12 active OP training programs were identified, primarily concentrated in the Southeast. Most programs were distance learning, limiting opportunities for practical training. Temporal analysis revealed a decline in OP specialist registrations over the past two decades, despite population growth.

Conclusions: Brazil faces challenges in OP training, including insufficient specialists, uneven regional distribution and limited hands-on training opportunities. The expansion of hybrid training models and the promotion of the OP specialty among dental students are vital to address these issues. Collaborative efforts between educational institutions, professional organizations, and the government are essential to strengthen the specialty and improve early diagnosis rates of oral cancer.

Background: Large language models (LLMs), such as ChatGPT, have demonstrated potential in synthesizing complex clinical information, yet concerns persist regarding their accuracy and reliability in specialized domains. The rationale of this study is to address a gap in the literature by evaluating ChatGPT-4o's capabilities and limitations in terms of accuracy and reliability on oral and maxillofacial traumatology.

Material and methods: A total of 188 oral and maxillofacial trauma-related questions were selected from a comprehensive resource. Thirty questions were randomly chosen and submitted to ChatGPT-4o resetting to "new chat" mode every repetition to eliminate potential memory bias. Accuracy was scored using a 3-point Likert scale. Reliability was assessed with weighted kappa (κ) and Intraclass Correlation Coefficient (ICC), and internal consistency was evaluated using both Cronbach's alpha (α) and McDonald's omega (ω).

Results: The accuracy rates for comprehensive and adequate responses were calculated as 38% (95% CI: 32.5% - 43.5%) and 58% (95% CI: 52.1% - 63.3%), respectively. Weighted kappa (κ = 0.469) and ICC (0.503) indicated moderate reliability. Internal consistency metrics revealed excellent and good reliability, respectively (α = 0.904, ω = 0.860).

Conclusions: ChatGPT-4o demonstrated promising results as an adjunct tool in providing supplementary educational content, verifying critical information, and supporting the decision-making processes in oral and maxillofacial traumatology. Current limitations warrant further research. Future enhancements in LLMs and prompt engineering may assist in the optimization of their clinical applicability and alignment with evidence-based standards.

Background: This study aims to compare stresses from vertical and oblique forces on pterygoid and zygomatic implants, combined with dental implants, in a atrophic maxilla using finite element stress analysis.

Material and methods: A computed tomography scan was used to create a geometric model of a completely edentulous adult maxilla. The maxillary bone was scanned using cone beam computed tomography (ILUMA, Orthocad, CBCT, 3M Imtec, Oklahoma, USA), and the obtained sections were transferred to the 3D-Doctor (Able Software Corp., MA, USA) software. Two models were created in the study. In the first model, zygomatic and dental implants were used, while in the second model, pterygoid and dental implants were used. A 150 N vertical force and a 100 N oblique force at a 30-degree buccolingual angle were applied. With finite element analysis assessed stress distribution in the implants and peri-implant bone tissue.

Results: When the obtained stress data were examined, under vertical forces, the maximum stress on the implants was higher in Model 1 (151.984 MPa) compared to Model 2 (151.773 MPa), but no significant difference was observed. The stress formed in the metal substructure was higher in Model 2 (422.042 MPa) compared to Model 1 (308.376 MPa). The maximum principal stress in the alveolar bone was greater in Model 2 (46.866 MPa) compared to Model 1 (15.719 MPa), and the minimum principal stress in the alveolar bone was also greater in Model 2 (80.360 MPa) compared to Model 1 (76.310 MPa). Under oblique forces, the average stress on the implants was higher in Model 2 (128.297 MPa) than in Model 1 (79.607 MPa).

Conclusions: When the stresses occurring on zygomatic and pterygoid implants and the alveolar bone surrounding these implants were compared, it was observed that the use of zygomatic implants was more beneficial in reducing both dental and biomechanical stress.

Background: Mandibular fractures are common injuries, leading to various complications, including obstructive sleep apnea (OSA). The aim of this study was to evaluate the occurrence of OSA in relation to mandibular fracture type before and after treatment using the STOP-BANG questionnaire.

Material and methods: This prospective study was conducted on patients admitted to Shahid Kamyab Hospital from 2022 to 2023 with mandibular fractures. Patients were classified based on the type and location of fracture, age, gender, and cause. The primary predictor variable was the type of mandibular fracture. The primary outcome variable was the occurrence of OSA as measured by the STOP-BANG questionnaire. Secondary outcomes included changes in STOP-BANG scores over time before and after treatment. Covariates were divided into age and gender (demographic), type of surgical treatment, and Body Mass Index (physiologic). Data analyses included comparisons of STOP-BANG scores over multiple time points (pre-fracture [T0], post-fracture [T1], 1 week post-surgery [T2], and 1 month post-surgery [T3]). The results were analyzed using SPSS 16 software, with a significance level set at p-value < 0.05.

Results: In this study, 154 patients were examined. Ninety-five patients had unilateral fractures and 59 patients had bilateral fractures. The study groups were homogeneous in terms of age, gender, surgical method, and Body Mass Index (BMI). In both unilateral and bilateral groups, the average STOP-BANG score changed significantly over time (p<0.001). Pairwise comparisons indicated that the STOP-BANG score significantly increased at all times compared to pre-fracture, but decreased significantly at each subsequent time point after the fracture. The mean STOP-BANG score was significantly higher in the bilateral group compared to the unilateral group at each time point (T1, T2, T3) (p<0.001). The mean changes in STOP-BANG score relative to T0 were significantly greater in the bilateral group compared to the unilateral group (p<0.001).

Conclusions: Mandibular fractures affect respiratory conditions and can lead to OSA. Surgeons should consider the reduction in respiratory space when treating these patients and choose an appropriate treatment plan. Bilateral fractures are more likely to lead to OSA, whereas OSA occurrence was rarely observed in cases of unilateral fractures.

Background: Metastatic melanoma of the major salivary gland has been rarely reported in the literature. Thus, the aim of this study was to integrate all data about the clinical, sociodemographic, histopathological, treatment, and follow-up characteristics of metastatic melanoma of the major salivary glands.

Material and methods: Electronic searches were performed in five databases and the grey literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Case reports or case series describing metastatic melanoma of the major salivary gland without language or year of publication restriction were included.

Results: Twenty-five studies reporting 47 cases of metastatic melanoma were identified. The mean patient age at diagnosis was 56.321.5 years, mainly occurring in men (70.2%). The site of the primary melanoma was mostly in the head and neck region (65%) and the parotid (93.6%) was the most affected major salivary gland by metastatic lesions. Parotidectomy was the main treatment choice. The overall 1- and 5-year survival rates were 79% and 45%, respectively.

Conclusions: Metastatic melanoma of the major salivary gland is an uncommon phenomenon involving a poor prognosis.

Background: This study describes the clinical and histopathological profile of 22 subgemmal neurogenous plaques (SNP) through a 52-year retrospective study conducted at an Oral Pathology referral center in the Northeast of Brazil.

Material and methods: Clinical data (age, biological sex, symptoms, clinical presentation, lesion size, duration at diagnosis, growth rate, implantation, and consistency) were retrieved from biopsy records. Hematoxylin and eosin-stained slides from all selected cases were re-evaluated.

Results: SNPs accounted for 0.12% (n = 22) of all lesions diagnosed at the center. A predominance among female patients was observed (n = 20; 90.9%), with most diagnoses occurring in the fifth to sixth decades of life (mean 57.5 ​ ± 12.19 years). Clinically, the lesions typically presented as slow-growing but painful, reddish papules. Five cases were associated with oral lymphoepithelial cysts. Histologically, common features included spindle cells, subepithelial nerve plexuses, ganglion cells, mast cells, lymphoid tissue, and germinal centers.

Conclusions: These findings underscore the importance of recognizing the clinical and histopathological characteristics of SNPs to avoid misdiagnosis as neural tumors.