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Louredo BVR, Penafort PVM, Roza ALOC, Oliveira MCQD, Ocaña RP, Torres AM, Ferreira Júnior SDB, Rocha AC, Costa RCD, Pires FR, Prado JD, Jorge-Júnior J, Vargas PA. Intraosseous benign peripheral nerve sheath tumor of the jaws: report of 4 new cases and a comprehensive literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2024:S2212-4403(24)00466-8. [PMID: 39353830 DOI: 10.1016/j.oooo.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/30/2024] [Accepted: 09/10/2024] [Indexed: 10/04/2024]
Abstract
Benign peripheral nerve sheath tumors (BPNSTs) are a vast, common, heterogeneous group of lesions that are often diagnostically challenging. The head and neck region is recognized as the second most common location for these lesions, especially the tongue. However, BPNSTs occurring centrally within the jaw bones are exceedingly rare. To date, approximately 161 cases of intraosseous BPNSTs have been reported in the jaws. This group mainly includes the relatively more common neurofibromas and schwannomas, and the less common perineuriomas and hybrid forms. Unlike soft tissues, schwannomas are the most common BPNSTs occurring within the jaws, followed by neurofibromas and perineuriomas. These neoplasms can present as a well-defined unilocular lesion or as an ill-defined multilocular image, resembling several types of benign and malignant lesions of odontogenic origin. The aim of the current study was to report 4 new cases of intraosseous BPNSTs and a comprehensive literature review.
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Affiliation(s)
- Brendo Vinícius Rodrigues Louredo
- Department of Oral Diagnosis, Oral Pathology Section, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Paulo Victor Mendes Penafort
- Department of Oral Diagnosis, Oral Pathology Section, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Ana Luiza Oliveira Corrêa Roza
- Department of Oral Diagnosis, Oral Pathology Section, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Maria Cecília Querido De Oliveira
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil Dental, São Paulo, Brazil; Oficial dentista da Polícia Militar do Estado de São Paulo (PM-SP), São Paulo, SP, Brazil
| | - Ricardo Pelletti Ocaña
- Oficial dentista da Polícia Militar do Estado de São Paulo (PM-SP), São Paulo, SP, Brazil
| | | | | | - André Caroli Rocha
- Divisão de Odontologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | | | - Fábio Ramoa Pires
- Oral Pathology Section, Dental School, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil; Valiante Pathology Laboratory, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Dentistry, Estácio de Sá University, Rio de Janeiro, RJ, Brazil
| | - José Divaldo Prado
- Department of Stomatology, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Jacks Jorge-Júnior
- Department of Oral Diagnosis, Oral Pathology Section, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Oral Pathology Section, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil.
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Leite AA, Pires TDL, Silva LC, Penafort PVM, Vargas PA. Lobulated nodule arising on the tongue in a young patient. Oral Dis 2023; 29:1379-1381. [PMID: 37075058 DOI: 10.1111/odi.14389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 04/20/2023]
Affiliation(s)
- Amanda Almeida Leite
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Tulio de Lucena Pires
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Luan César Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Paulo Victor Mendes Penafort
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
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A radiolucency in the posterior mandible. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:161-168. [PMID: 36229371 DOI: 10.1016/j.oooo.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
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Lenartowicz KA, Goyal A, Mauermann ML, Wilson TJ, Spinner RJ. Clinical Features, Natural History, and Outcomes of Intraneural Perineuriomas: A Systematic Review of the Literature. World Neurosurg 2021; 154:120-131.e8. [PMID: 34284162 DOI: 10.1016/j.wneu.2021.07.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intraneural perineurioma is a rare peripheral nerve sheath tumor characterized by localized proliferation of perineurial cells. The literature consists predominantly of case reports and institutional series, with inconsistent and confusing nomenclature. We present a pooled analysis of all reported cases of intraneural perineurioma in the literature. METHODS A systematic search of PubMed, MEDLINE, Embase, and Scopus was performed according to PRISMA guidelines to identify all reported cases of intraneural perineurioma in the literature. Individual cases were pooled and analyzed for demographics, clinical features, and outcomes. RESULTS A total of 172 cases were identified across 72 studies, of which 149 were found in major peripheral nerves and their branches. Median age of patients at diagnosis and onset of symptoms was 18 years (interquartile range [IQR], 12-34 years) years and 13.5 years (IQR, 8-26 years), respectively, with 54.4% (81/149) being female. The most common sites were the sciatic nerve or its branches (41.9%), median nerve (13.5%), radial nerve (12.2%), and brachial plexus (12.2%). Most patients were managed conservatively (52.9%; 72/136). Among those managed conservatively with available follow-up (n = 31), median follow-up was 11 months, and most (67.7%, n = 21) reported no change in neurologic status, although worsening was noted in 29.0% (9/31). Among surgically managed cases (n = 64), the most common intervention was resection with or without repair (62.5%; 40/64), neurolysis (25%; 16/64), or tendon transfers without resection (12.5%; 8/64). No lesion recurred after surgical resection. CONCLUSIONS Intraneural perineurioma represents a benign focal lesion presenting with weakness and atrophy affecting adolescents and young adults. Most cases are managed nonoperatively and surgical treatment strategies are varied.
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Affiliation(s)
| | - Anshit Goyal
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Thomas J Wilson
- Department of Neurologic Surgery, Stanford University, Palo Alto, California, USA
| | - Robert J Spinner
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Bergamini ML, Noberto LPM, Torres GBMDA, Soares HA, Martins F, Costa ALF, de Souza SOCM, Braz-Silva PH. Primary intra-osseous Hybrid Schwannoma-Perineurioma in the mandible. J Clin Exp Dent 2020; 12:e888-e891. [PMID: 32994880 PMCID: PMC7511049 DOI: 10.4317/jced.57035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/14/2020] [Indexed: 11/05/2022] Open
Abstract
Benign nerve sheath tumours include perineuriomas, schwannomas and neurofibromas. Hybrid schwannoma-perineurioma represents a cutaneous, subcutaneous or occasionally intra-osseous tumour with schwannian cytomorphology and perineurioma-like architecture consisting of a mixture of both types of cells. These tumours can develop at any age and there is no gender-predilection. Tongue is the most frequently affected site, followed by palate, mouth floor, jugal mucosa, lips and, more rarely, mandible. We present a case of hybrid tumour with schwannoma-perineurioma morphology located on the right mandibular body (intra-osseous) of a 54-year-old female patient. The tumour was symptomatic and evolving for six months. Microscopically, it was encapsulated and highly cellularised, presenting fascicular aspect and exhibiting scant mitotic activity. The tumour consisted of distinct cellular populations involving fusiform cells, cells with wavy and hyperchromatic nucleus or even epithelioid cells. Positive immunostaining for S-100 and epithelial membrane antigen (EMA) was observed. The lesion was completely removed under general anaesthesia, with the patient showing no clinical or radiographic sign of relapse after two-year follow-up. Despite the limited knowledge on the pathogenesis of Hybrid Schwannoma-Perineurioma, these tumours seem to present a non-aggressive biological behaviour. Conservative surgery provides adequate solution without recurrence, even after a long-term follow-up. Key words:Nerve sheath tumours, Schwannoma, Perineurioma, Immunohistochemistry.
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Affiliation(s)
- Mariana-Lobo Bergamini
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | | | - Haroldo-Arid Soares
- Division of Odontology, Municipal Hospital Carmino Caricchio, São Paulo, Brazil
| | - Fabiana Martins
- Department of Dentistry, University of Santo Amaro, São Paulo, Brazil
| | | | | | - Paulo-Henrique Braz-Silva
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.,Laboratory of Virology, Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil
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Ko E, McNamara K, Ditty D, Alawi F. Intraneural perineurioma of the mandible: case series of a rare entity. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:428-432. [PMID: 32868253 DOI: 10.1016/j.oooo.2020.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Eugene Ko
- University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA.
| | - Kristin McNamara
- The Ohio State University College of Dentistry, Columbus, OH, USA
| | - Douglas Ditty
- First State Oral and Maxillofacial Surgery, Dover, DE, USA
| | - Faizan Alawi
- University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA
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Elledge R, Nandra B, Bates T, Zardo D, Parmar S. Storiform collagenoma (sclerotic fibroma) of the oral mucosa. Br J Oral Maxillofac Surg 2020; 58:231-233. [PMID: 31761569 DOI: 10.1016/j.bjoms.2019.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
Storiform collagenoma (also called sclerotic fibroma) is uncommon, occurs as a cutaneous fibrous neoplasm, and is particularly rare in mucosal tissue in the head and neck. We describe an unexpected diagnosis in the oral cavity. Histopathological examination showed a proliferation of fibrous tissue, which was well circumscribed but unencapsulated, with thick laminated bundles of eosinophilic collagen that exhibited a storiform or "whorled" pattern. First described by Weary et al in 1972, storiform collagenoma is a marker for Cowden's disease or PTEN hamartoma tumour syndrome. Identification of other synchronous lesions should prompt chromosomal analysis for a mutation in the PTEN gene on chromosome 10q23.
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Affiliation(s)
- R Elledge
- University Hospitals Birmingham NHS Foundation Trust.
| | - B Nandra
- University Hospitals Birmingham NHS Foundation Trust.
| | - T Bates
- University Hospitals Birmingham NHS Foundation Trust.
| | - D Zardo
- University Hospitals Birmingham NHS Foundation Trust.
| | - S Parmar
- University Hospitals Birmingham NHS Foundation Trust.
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Rumayor Piña A, Flores Rodríguez O, Barbosa Rodríguez E, Vértiz Félix K, Flores Flores D. A 48-year-old female with an exophytic nodule in the buccal mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:95-99. [DOI: 10.1016/j.oooo.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 07/24/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
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Tamiolakis P, Chrysomali E, Sklavounou-Andrikopoulou A, Nikitakis NG. Oral neural tumors: Clinicopathologic analysis of 157 cases and review of the literature. J Clin Exp Dent 2019; 11:e721-e731. [PMID: 31598201 PMCID: PMC6776406 DOI: 10.4317/jced.55944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background Oral neural tumors (ONTs) are rare lesions and represent reactive or neoplastic proliferations of nerve sheath cells. The purpose of the present study is to report the clinical, demographic and histopathologic features of 157 ONTs diagnosed in a single Oral Pathology Department and review the pertinent literature. Material and Methods 157 cases of ONTs diagnosed during a 44-year period were retrospectively collected and the diagnosis was reconfirmed by studying representative haematoxylin and eosin stained tissue sections. The patients’ gender and age, as well as the main clinical features of the lesions, were retrieved from the biopsy submission forms. Results The 157 ONTs represented approximately 0.4% of 35,590 biopsies accessioned during the study period. They affected 71 male and 86 female patients with a mean age of 38.4±18.8 years. They mainly appeared as asymptomatic nodules of normal or white colour on the tongue, lip mucosa and hard palate. The most common ONT was granular cell tumour (38.9%) followed by neurofibroma (19.7%), schwannoma (15.9%), traumatic neuroma (15.9%), palisaded encapsulated neuroma (8.3%) and nerve sheath myxoma (1.3%). Conclusions This study confirmed the rarity of ONTs. Their clinical characteristics mimic other oral lesions; thus, microscopic examination is the only mean to arrive at a definitive diagnosis. Key words:Oral neural tumors; oral neural neoplasms; neurofibroma; oral neurofibroma; schwannoma; oral schwannoma; neurilemmoma; oral neurilemmoma; granular cell tumor; oral granular cell tumor; traumatic neuroma; oral traumatic neuroma; palisaded encapsulated neuroma; oral palisaded encapsulated neuroma.
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Affiliation(s)
- Paris Tamiolakis
- DDS, MSc, Department of Oral Medicine and Pathology, Department of Dentistry, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Evanthia Chrysomali
- DDS, PhD, Associate Professor, Department of Oral Medicine and Pathology, Department of Dentistry, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Alexandra Sklavounou-Andrikopoulou
- DDS, MSc, PhD, Professor, Department of Oral Medicine and Pathology, Department of Dentistry, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Nikolaos G Nikitakis
- MD, DDS, PhD, Professor, Head of Department of Oral Medicine and Pathology, Department of Dentistry, School of Health Sciences, National and Kapodistrian University of Athens, Greece
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Kurihara J, Yokoo S, Ichikawa M, Shimizu T, Ogawa M, Seki M. Intraosseous intraneural perineurioma derived from the inferior alveolar nerve with an abnormality of chromosome 22 and expression of the BCR-ABL fusion gene: report of a case and review of recent literature. World J Surg Oncol 2018; 16:189. [PMID: 30213264 PMCID: PMC6137890 DOI: 10.1186/s12957-018-1481-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 08/21/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Perineurioma (PN) is a peripheral nerve disease that primarily develops in the limbs and trunk and very rarely occurs in the oral cavity. PN is classified into two types: intraneural perineurioma (INPN) and soft tissue perineurioma (extraneural perineurioma, ENPN). In this article, we report a patient with mandibular body INPN derived from the perineurium of the inferior alveolar nerve. CASE PRESENTATION The patient was a 43-year-old male. He consulted our department for a detailed examination of the right mandibular body. A biopsy was performed at another hospital and he was diagnosed with a schwannoma. At his first visit, hypesthesia extending from the right lower lip to the mental region was recognized and enlargement of the right mandibular canal was confirmed with X-ray CT and MRI. Considering the possibility of future tumor growth, we extirpated the tumor under general anesthesia. Cystic tumor was seen continuously in the inferior alveolar nerve. Immunohistologically, the tumor cells were positive for Glut-1, weakly positive for EMA, and weakly positive for Claudin-1, and the histopathological diagnosis was INPN. In addition, absence of the BCR region of chromosome 22 and expression of the BCR-ABL fusion gene were observed by fluorescent in situ hybridization (FISH), and a chromosome 22 abnormality was confirmed. These findings indicated that the disease was a neoplastic lesion. CONCLUSION Expression of the BCR-ABL fusion gene in INPN that develops in the oral cavity is thought to be very rare, and to the best of our knowledge, ours is the first case to be reported in the literature. About three postoperative years have passed, but findings suggestive of recurrence have not been observed.
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Affiliation(s)
- Jun Kurihara
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, 4-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Satoshi Yokoo
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, 4-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Miku Ichikawa
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, 4-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takahiro Shimizu
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, 4-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Masaru Ogawa
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, 4-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Mai Seki
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, 4-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.,Department of Pathological Diagnostics, Gunma University Graduate School of Medicine, 4-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Franco T, de Freitas Filho SAJ, Muniz LB, de Faria PR, Loyola AM, Cardoso SV. Oral peripheral nerve sheath tumors: A clinicopathological and immunohistochemical study of 32 cases in a Brazilian population. J Clin Exp Dent 2018; 9:e1459-e1465. [PMID: 29410763 PMCID: PMC5794125 DOI: 10.4317/jced.54338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/05/2017] [Indexed: 12/12/2022] Open
Abstract
Background Oral peripheral nerve sheath tumors (OPNSTs) are reactive or neoplastic diseases that develop from proliferation of the nerve itself or their limiting sheaths. Here we describe the clinicopathologic data of OPNSTs observed in a sample of the Brazilian population and evaluate the expression of molecules associated with neural biology to determine their usefulness in the diagnosis. Material and Methods Descriptive study of cases diagnosed as OPNSTs, from the Pathology Laboratory at the School of Dentistry/ Federal University of Uberlandia, followed by an immunohistochemical study of S-100, CD57, neurofilament protein (NFP) and epithelial membrane antigen (EMA). Results OPNSTs comprised 0.27% of all biopsies. There were eight patients with neurofibromas, eight with traumatic neuromas, seven with schwannomas, five with granular cell tumor (GCT), and four with palisaded encapsulated neuromas (PEN). Women were more frequently affected (60.6% of the cases). Tongue and lips prevailed as the most frequent sites. S-100 was reactive in 100% of the cases. Neural fibers evidenced by CD57 reactivity of their Schwann cells were always nested in bundles within neurofibromas and GCT, absent within schwannomas and dispersed within PEN. Reactivity for NFP was limited to axons and then followed the same pattern of CD57, though much less evident. Reactivity for EMA was observed in the capsular tissues and perineurium of nerve fascicles, and absent in parenchymal cells of GCT. Conclusions This study showed that OPNSTs are rare, widely benign and often found in tongue and lips. OPNSTs evolve from a common origin to distinct histological patterns, with eventual overlapping in their clinical and morphologic features. The arrangement of reactive residual neural fibers for CD57 can be a useful staining in the differential diagnosis of OPNSTs. Key words:Peripheral nerve sheath tumors. Oral cavity. Differential diagnosis. Immunohistochemistry. CD57 antigens.
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Affiliation(s)
- Talita Franco
- DDS, MSc, Area of Pathology, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | | | - Laís-Borges Muniz
- DDS, MSc, Area of Pathology, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Paulo-Rogério de Faria
- DDS, MSc, PhD, Professor, Department of Morphology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Adriano-Mota Loyola
- DDS, MSc, PhD, Professor, Area of Pathology, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Sérgio-Vitorino Cardoso
- DDS, MSc, PhD, Professor, Area of Pathology, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
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