Quality of life of patients following orthognathic surgery

The aim of this study was to evaluate how patients with dentofacial deficiency who have undergone orthognathic surgery perceive their quality of life (QoL) with respect to functional, esthetic, and psychosocial issues. In an observational, cross-sectional, descriptive, and quantitative study, 10 patients who had undergone orthognathic surgery answered questionnaires used internationally for assessing QoL: the Short Form Health Survey (SF-36), Oral Health Impact Profile 14 (OHIP-14), and Orthognathic Quality of Life Questionnaire (OQLQ). In addition, the patients completed the Self-Perception Questionnaire of Esteem, Appearance, and Interpersonal Relationships (ASR-26), which explored the differences between their current self-esteem, appearance satisfaction, and interpersonal relationships and their memories of their presurgical feelings about those topics. The data were submitted to descriptive and multivariable statistical analyses. There was a statistically significant difference between the preoperative and postoperative periods regarding self-esteem, appearance satisfaction, and professional relationships (P < 0.05). The data collected with the SF-36, OHIP-14, and OQLQ questionnaires showed high internal consistency (Cronbach α coefficient). The index (mean) scores for the SF-36 (81.5), OHIP-14 (0.6), and OQLQ (5.0) were close to the conditions of high QoL. Principal component analysis revealed 3 distinct groups of patients, and 70% of patients composed a group with high QoL scores, showing no complaints of physical pain, functional limitation, psychological discomfort, social disability, or excessive concern about their oral condition. In this small sample of patients, orthognathic surgery resulted in improved health-related QoL with variations among patients regarding physical pain, psychological discomfort, oral function, facial esthetics, physical function, social function, and self-awareness of facial deformity. The results of this study indicate the importance of applying a questionnaire in individuals who have undergone orthognathic surgery to investigate their personal motivations for treatment and which physical, social, and psychological problems are limiting their QoL.

Oral leukoplakia-epidemiological survey and histochemical analysis of 107 cases in Brazil

OBJECTIVE

To perform an epidemiological survey comparing the cell proliferative activity of 107 cases of oral leukoplakia with their clinical and histopathological characteristics.

MATERIALS AND METHODS

A cross-sectional, observational, and histological-histochemical study. The cases came from the Histopathological Diagnostic Service of UPF/RS and the School of Dentistry of Araçatuba FOA/UNESP/SP (1986-2016). The histopathological sections were stained using the silver staining (AgNOR) technique and the nuclei of 100 epithelial cells selected randomly were recorded to count the number of nucleolar organizer regions (NORs). The mean NORs per lesion were correlated to clinical and histological characteristics using ANOVA, at 5% significance.

RESULTS

Most of the cases included men (62.62%), white (64.49%), and with an average age of 53.94 years. The most probable etiological factors were smoking (44.7%) and alcohol consumption (9.85%). The evolution time of most lesions was fast (33.65%), manifesting mainly in the form of plaques (70.37%) and without symptoms (58.88%). They were located mainly in the cheek mucosa (26.62%) and presented white color (66.35%), well-defined edges (59.81%), firm consistency (47.5%), and keratinized surface (49.53%). Etiological factor (p = 0.003), evolution time (p = 0.006), symptoms (p = 0.029), location (p = 0.020), consistency (p = 0.047), histopathological characteristics (p = 0.004), and superficial keratinization (p = 0.001) were statistically significant regarding the mean NORs of the leukoplakias studied.

CLINICAL RELEVANCE

Oral leukoplakias caused by alcohol consumption and/or tobacco use, considering an evolution time of fewer than 12 months, asymptomatic, located in the lower lip or tongue, and with a firm consistency and increased superficial keratinization should be treated more aggressively by the clinician to avoid cancerization.

Morse taper performance: A finite element analysis study

OBJECTIVES

To evaluate and compare the magnitude and distribution of stresses generated on implants, abutments and first molar metal-ceramic crowns using finite element analysis.

METHODS

Preliminary three-dimensional models were created using the computer-aided design software SolidWorks. Stress and strain values were observed for two distinct virtual models: model 1 - Morse taper and solid abutment; model 2 - Morse taper and abutment with screw. A load (250 N) was applied to a single point of the occlusal surface at 15° to the implant long axis. Von Mises stresses were recorded for both groups at four main points: 1) abutment-retaining screws; 2) abutment neck; 3) cervical bone area; 4) implant neck.

RESULTS AND CONCLUSION

Model 1 showed a higher stress value (1477.5 MPa) at the abutment-retaining screw area than the stresses found in model 2 (1091.1 MPa for the same area). The cervical bone strain values did not exceed 105 µm for either model.

Peri-implant assessment via cone beam computed tomography and digital periapical radiography: an ex vivo study

OBJECTIVES

This research evaluated detail registration in peri-implant bone using two different cone beam computer tomography systems and a digital periapical radiograph.

METHODS

Three different image acquisition protocols were established for each cone beam computer tomography apparatus, and three clinical situations were simulated in an ex vivo fresh pig mandible: buccal bone defect, peri-implant bone defect, and bone contact. Data were subjected to two analyses: quantitative and qualitative. The quantitative analyses involved a comparison of real specimen measures using a digital caliper in three regions of the preserved buccal bone - A, B and E (control group) - to cone beam computer tomography images obtained with different protocols (kp1, kp2, kp3, ip1, ip2, and ip3). In the qualitative analyses, the ability to register peri-implant details via tomography and digital periapical radiography was verified, as indicated by twelve evaluators. Data were analyzed with ANOVA and Tukey's test (α=0.05).

RESULTS

The quantitative assessment showed means statistically equal to those of the control group under the following conditions: buccal bone defect B and E with kp1 and ip1, peri-implant bone defect E with kp2 and kp3, and bone contact A with kp1, kp2, kp3, and ip2. Qualitatively, only bone contacts were significantly different among the assessments, and the p3 results differed from the p1 and p2 results. The other results were statistically equivalent.

CONCLUSIONS

The registration of peri-implant details was influenced by the image acquisition protocol, although metal artifacts were produced in all situations. The evaluators preferred the Kodak 9000 3D cone beam computer tomography in most cases. The evaluators identified buccal bone defects better with cone beam computer tomography and identified peri-implant bone defects better with digital periapical radiography.

Evaluation of cellular proliferative activity in patients with oral lichen planus and hepatitis C through AgNOR method

The objective of this study was to evaluate the cellular proliferative potential of oral lichen planus (OLP) lesions from patients without hepatitis C virus (HCV) by means of AgNOR method, as well as the cellular proliferative potential of the normal oral mucosa from patients with HCV, treated or untreated by interferon and ribavirin. A cross-sectional study was developed to investigate four groups: 10 HCV+ patients without clinical signs of OLP who had never been treated for HCV infection - Group 1; 10 HCV+ patients that were under interferon and ribavirin treatment - Group 2; 15 patients with reticular OLP lesions histopathologically confirmed, without HCV - Group 3; and 15 blood donors without HCV infection and no clinical signs of OLP GROUP 4 Control Group. The cytological material of all groups was collected by the liquid-based cytology technique. Then, the sedimented material from each patient was filled with the Nucleolar Organizer Regions impregnation by silver method (AgNOR). The count of NORs was performed on 100 epithelial cell nuclei per patient using the Image Tool(tm) software. The Tukey HSD test was used to compare the median value of NORs among the groups and showed that the oral mucosa of HCV+ patients previously treated with anti-HCV drugs (GROUP 2), presented a higher average number of NORs in relation to others (p<0.05). The anti-HCV treatment may be related to increased cell proliferation of oral mucosa, indicating a possible relationship between OLP and HCV+ patients treated with interferon and ribavirin.

Hepatitis C and Oral Lichen Planus: Evaluation of their Correlation and Risk Factors in a Longitudinal Clinical Study

OBJECTIVE

The aim of this study is to evaluate the correlation between hepatitis C virus (HCV) infection and oral lichen planus (OLP), and further examine the relationship between age, sex, systemic diseases and drugs with the presence of HCV infection or OLP.

MATERIAL AND METHODS

A longitudinal clinical study was carried out from March 2010 to December 2013 with 51 individuals, of whom 33 had been presented with HCV (HCV-positive group) and 18 had OLP (OLP-positive group), in Passo Fundo, RS, Brazil. Hepatitis C virus-positive individuals who presented lesions compatible with OLP were subjected to an intraoral biopsy for histopathological diagnosis, while OLP-positive individuals underwent anti-HCV serological test for diagnosis of HCV infection. Data on age, sex, systemic diseases and drugs used were recorded for later analysis. The data were analyzed using descriptive statistics of frequency and by Pearson's Chi-square test, with a 5% significance level (p < 0.05).

RESULTS

Out of the 33 HCV-positive individuals, only one was clinically and pathologically positive for OLP, demonstrating a significant relationship between the presence of HCV infection and the manifestation of OLP (Chi-square test -46.852, p = 7.65 × 10(-12)). None of the individuals in OLP-positive group had HCV infection. The most common systemic diseases were hypertension and diabetes, and the most commonly used drugs were antihypertensives. However, there was no significant relationship between these factors and the presence of OLP or HCV infection (p > 0.05).

CONCLUSION

There was a significant relationship between HCV infection and manifestation of OLP. Age, sex, systemic diseases and drugs were not identified as risk factors for the development of these diseases.

CLINICAL SIGNIFICANCE

The OLP could serve as an indicative of HCV infection in asymptomatic patients, thus enabling early diagnosis and treatment of hepatitis and hence, a better prognosis.