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Ari I, Adiloglu S, Aktas A, Yasan GT, Usman E, Aksoy S. Incidence, treatment method and recurrence rate in giant cell granulomas: Retrospective study. J Craniomaxillofac Surg 2024; 52:697-703. [PMID: 38641523 DOI: 10.1016/j.jcms.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 03/12/2024] [Indexed: 04/21/2024] Open
Abstract
Central and peripheral giant cell granulomas are benign entities mostly seen in mandibular anterior region at female individuals, usually with observed recurrence. Their etiology is still unclear, as is the optimal method for treating them. The aim of this study was to evaluate the incidence, treatment methods, recurrence rates, and initial and definitive correlation of central and peripheral giant cell granulomas. Patients who were referred to our clinic between 2013 and 2023 and who had the lesions' definitive diagnosis as "central giant cell granuloma" (CGCG) or "peripheral giant cell granuloma" (PGCG) were included in the study. Demographic data, recurrence rates, treatment methods, lesion location, clinical behaviors, and sizes were noted on the reports. A total of 30 lesions in 23 patients (14 PGCG and 9 CGCG) were evaluated in this study. The mean follow-up time was 62.6 months; 8 of 23 patients had systemic disease. While only 1 patient was observed to have cortical bone destruction in PCGC, all patients were found to have cortical bone destruction in CGCG (p < 0.05). In both lesions, the correlation of preliminary and definitive diagnosis was evaluated, and it was found to be 50% in PGCG while it was 77.7% in CGCG. The recurrence rates were 21.4% in PGCG and 33.3% in CGCG. Curettage was applied in all patients. Additional treatments (intralesional steroid injections, denasumab applications, resection, and graft application) were performed in 5 patients who were found to have CGCG (p = 0.004). However, there was no significant relation between treatment method and recurrence in CGCG (p > 0.05). Various peripheral lesions could mimic PGCG; thus, curettage therapy could be appropriate in the treatment of PGCG. Nevertheless, in some cases of CGCG, additional treatment methods could be more effective for preventing recurrence and any other complications.
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Affiliation(s)
- Ilgin Ari
- Hacettepe University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey.
| | - Selen Adiloglu
- Hacettepe University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Alper Aktas
- Hacettepe University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Göknur Topaloglu Yasan
- Hacettepe University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Ecem Usman
- Hacettepe University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Sena Aksoy
- Hacettepe University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
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2
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Lomeli Martinez SM, Carrillo Contreras NG, Gómez Sandoval JR, Zepeda Nuño JS, Gomez Mireles JC, Varela Hernández JJ, Mercado-González AE, Bayardo González RA, Gutiérrez-Maldonado AF. Oral Pyogenic Granuloma: A Narrative Review. Int J Mol Sci 2023; 24:16885. [PMID: 38069207 PMCID: PMC10706684 DOI: 10.3390/ijms242316885] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Pyogenic granuloma (PG) is a benign vascular lesion found predominantly in the oral cavity. Characterized by rapid growth and propensity to bleed, PG presents diagnostic challenges due to its similarity and alarming proliferation. This narrative review synthesizes current knowledge on the epidemiology, etiopathogenesis, clinical manifestations, and management of oral PG, with emphasis on recent advances in diagnostic and therapeutic approaches. The epidemiology of the injury is meticulously analyzed, revealing a higher incidence in women and a wide range of ages of onset. It delves into the etiopathogenesis, highlighting the uncertainty surrounding the exact causal factors, although historical attributions suggest an infectious origin. It exhaustively analyzes the clinical and histopathological aspects of oral PG, offering information on its various presentations and the importance of an accurate diagnosis to guide effective treatment. It details treatment strategies, emphasizing the personalized approach based on individual patient characteristics. This comprehensive review consolidates current knowledge on oral PG, highlighting the need for further research to clarify its pathogenesis and optimize treatment protocols.
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Affiliation(s)
- Sarah Monserrat Lomeli Martinez
- Department of Medical and Life Sciences, University of Guadalajara (CUCiénega-UdeG), 1115 Ave. Universidad, Ocotlán 47810, Jalisco, Mexico; (S.M.L.M.); (J.J.V.H.)
- Master of Public Health, Department of Wellbeing and Sustainable Development, University of Guadalajara (CUNorte-UdeG), 23 Federal Highway, Km. 191, Colotlán 46200, Jalisco, Mexico
- Periodontics Program, Department of Integrated Dentistry Clinics, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico; (N.G.C.C.); (J.R.G.S.); (J.C.G.M.)
- Prostodontics Program, Department of Integrated Dentistry Clinics, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico
| | - Nadia Guadalupe Carrillo Contreras
- Periodontics Program, Department of Integrated Dentistry Clinics, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico; (N.G.C.C.); (J.R.G.S.); (J.C.G.M.)
| | - Juan Ramón Gómez Sandoval
- Periodontics Program, Department of Integrated Dentistry Clinics, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico; (N.G.C.C.); (J.R.G.S.); (J.C.G.M.)
- Research Institute of Dentistry, Department of Integrated Dentistry Clinics, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico
| | - José Sergio Zepeda Nuño
- Microbiology and Pathology Department, Pathology Laboratory, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico;
| | - Juan Carlos Gomez Mireles
- Periodontics Program, Department of Integrated Dentistry Clinics, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico; (N.G.C.C.); (J.R.G.S.); (J.C.G.M.)
| | - Juan José Varela Hernández
- Department of Medical and Life Sciences, University of Guadalajara (CUCiénega-UdeG), 1115 Ave. Universidad, Ocotlán 47810, Jalisco, Mexico; (S.M.L.M.); (J.J.V.H.)
| | - Ana Esther Mercado-González
- Antiguo Hospital Civil de Guadalajara “Fray Antonio Alcalde”, 777 Coronel Calderón, Guadalajara 44200, Jalisco, Mexico;
| | - Rubén Alberto Bayardo González
- Department of Integrated Dentistry Clinics, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico;
| | - Adrián Fernando Gutiérrez-Maldonado
- Department of Medical and Life Sciences, University of Guadalajara (CUCiénega-UdeG), 1115 Ave. Universidad, Ocotlán 47810, Jalisco, Mexico; (S.M.L.M.); (J.J.V.H.)
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3
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Abofoul S, Hurvitz AZ, Grienstein OK, Shuster A, Vered M, Edel J, Kaplan I. Peripheral giant cell granuloma associated with dental implants: Case-series. Clin Implant Dent Relat Res 2022; 24:133-137. [PMID: 34981625 DOI: 10.1111/cid.13063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The objectives were to characterize clinico-pathologically a large series of peri-implant peripheral giant cell granuloma (PGCG), and investigate the role of foreign material as a possible etiological factor. MATERIAL AND METHODS The study was retrospective, conducted on peri-implant specimens submitted for histology between 2005 and 2021. RESULTS Three hundred and thirty-five peri-implant biopsies were retrieved, of which 52 (15.5%) were PGCG. The study population included 28 females and 24 males, age 35-92 years, mean 61. 51.2% reported bone involvement. The lesion involved the margins of the specimen in 65.3%, recurrence was reported in 46.1%. In 58.8% the implant was removed at the same time the specimen was submitted for histopathological analysis. Small foci of black granular foreign material were observed in 53.8% of cases of which 67.8% were birefringent under polarized light. The foreign material granules were not ingested inside multinucleated giant cells, but were scattered in the stromal compartment. CONCLUSIONS Peri-implant PGCG is locally aggressive, with frequent bone involvement and high recurrence rate, resulting in implant loss in the majority of cases. The high recurrence rate may be related to conservative or inadequate surgery. Foreign material although common does not seem to have a role in its development.
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Affiliation(s)
- Samar Abofoul
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ayelet Zlotogorski Hurvitz
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Osnat Koren- Grienstein
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Shuster
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Department of Oral and Maxillofacial Surgery, Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Marilena Vered
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jeremy Edel
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilana Kaplan
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Sharma N, Rana S, Jetley S. Peripheral giant cell granuloma of maxilla. J Indian Soc Periodontol 2022; 26:75-78. [PMID: 35136321 PMCID: PMC8796777 DOI: 10.4103/jisp.jisp_624_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/08/2021] [Accepted: 05/08/2021] [Indexed: 11/04/2022] Open
Abstract
It is often documented that chronic irritation could be an etiology of oral cancer; yet out of negligence little heed is paid to any sort of discomfort until it grows to a sizable mass where it is difficult to go unnoticed. Intraorally, the source of irritation could vary from a jagged tooth edge to a chronic cheek bite. Furthermore, the removable prosthesis and orthodontic appliances can lead to alteration of the oral mucosal tissue. This case report represents one such sequelae of an ill-fitting dental prosthesis. Surprisingly and unfortunately, the broken denture was still in use by the patient until the damage caused by it could no further be ignored, it is then that the patient sought medical help. A histopathological diagnosis of reparative giant cell granuloma was made, and the patient was treated by successful excision of the same.
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Affiliation(s)
- Nilima Sharma
- Department of Dentistry, Hamdard Institute of Medical Sciences and Research and Associated HAHC Hospital, Jamia Hamdard, New Delhi, India
| | - Safia Rana
- Department of Pathology, Hamdard Institute of Medical Sciences and Research and Associated HAHC Hospital, Jamia Hamdard, New Delhi, India
| | - Sujata Jetley
- Department of Pathology, Hamdard Institute of Medical Sciences and Research and Associated HAHC Hospital, Jamia Hamdard, New Delhi, India
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5
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Friedrich RE, WÜsthoff F, Luebke AM, Kohlrusch FK, Wieland I, Zenker M, Gosau M. KRAS Mutation in an Implant-associated Peripheral Giant Cell Granuloma of the Jaw: Implications of Genetic Analysis of the Lesion for Treatment Concept and Surveillance. In Vivo 2021; 35:947-953. [PMID: 33622887 DOI: 10.21873/invivo.12335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/16/2022]
Abstract
The aim of this case report was to detail diagnosis and therapy in a case of implant-associated peripheral giant cell granuloma (IA-PGCG) of the jaw. Case Report: The 41-year-old female attended the outpatient clinic for treatment of recurrent mandibular IA-PGCG. The lesion was excised and the defect was closed with a connective tissue graft of the palate. Healing of oral defects was uneventful, and no local recurrence has occurred during a follow-up of 7 months. Genetic examination of the lesion identified a somatic mutation in KRAS. Conclusion: The lesions are assessed as reactive-inflammatory changes in the mucous membrane of the oral cavity. The cause of the lesion is unknown. KRAS mutations are commonly found in various cancer tissues, but also in germline and mosaic RASopathies. Recently, KRAS mutations have been identified in several IA-PGCG. The clinical course of a frequently locally recurring lesion gives rise to the assumption that lesions of this type show characteristics known in benign neoplasms.
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Affiliation(s)
- Reinhard E Friedrich
- Department of Oral and Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany;
| | - Falk WÜsthoff
- Department of Oral and Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Andreas M Luebke
- Institute of Pathology, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Felix K Kohlrusch
- Department of Oral and Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Ilse Wieland
- Institute of Human Genetics, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Martin Zenker
- Institute of Human Genetics, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
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6
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Román-Quesada N, González-Navarro B, Izquierdo-Gómez K, Jané-Salas E, Marí-Roig A, Estrugo-Devesa A, López-López J. An analysis of the prevalence of peripheral giant cell granuloma and pyogenic granuloma in relation to a dental implant. BMC Oral Health 2021; 21:204. [PMID: 33892689 PMCID: PMC8067650 DOI: 10.1186/s12903-021-01566-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 04/14/2021] [Indexed: 11/26/2022] Open
Abstract
Background The aim of the present investigation was to evaluate the literature recurrence of peripheral giant cell granuloma and pyogenic granuloma associated with dental implants. It’s important to know the characteristics present in these lesions and possible effects on the prognosis of dental implants. Methods An electronic search without time restrictions was done in the databases: PubMed/Medline. With the keywords "Granuloma" OR "Granuloma, Giant Cell" OR "peripheral giant cell" OR "Granuloma, Pyogenic” AND "Dental implants" OR "Oral implants”.
Results After applying the inclusion and exclusion criteria, a total of 20 articles were included, which reported 32 lesions (10 pyogenic granulomas, 21 peripheral giant cell granulomas and one peripheral giant cell granuloma combined with peripheral ossifying fibroma, all associated with implants). According to our review, these lesions are more frequent in males and in the posterior region of the mandible. Both excision and curettage of the lesion, compared to only excision, presented similar recurrences (40%). Explantation of the implant was performed in 41% of cases without additional recurrences. The results are not statistically significant when comparing one lesion to the other in terms of explantation (p = 0.97), recurrence (p = 0.57) or bone loss (p = 0.67). Conclusions The main therapeutic approach is tissue excision. The lesions show a high recurrence rate (34.4%), which often requires explantation of the associated implant. This recurrence rate is not affected by curettage after excision.
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Affiliation(s)
- Nieves Román-Quesada
- Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, Barcelona, Spain
| | - Beatriz González-Navarro
- Department of Odontoestomatology, Faculty of Medicine and Health Sciences (Dentistry), Bellvitge Campus, University of Barcelona, Barcelona, Spain.,Oral Health and Masticatory System Group, Institut D'Investigació Biomédica de Bellvitge (IDIBELL, Bellvitge Institute of Biomedical Research), L'Hospitalet de Llobregrat, Barcelona, Spain
| | - Keila Izquierdo-Gómez
- Department of Odontoestomatology, Faculty of Medicine and Health Sciences (Dentistry), Bellvitge Campus, University of Barcelona, Barcelona, Spain.,Oral Health and Masticatory System Group, Institut D'Investigació Biomédica de Bellvitge (IDIBELL, Bellvitge Institute of Biomedical Research), L'Hospitalet de Llobregrat, Barcelona, Spain
| | - Enric Jané-Salas
- Department of Odontoestomatology, Faculty of Medicine and Health Sciences (Dentistry), Bellvitge Campus, University of Barcelona, Barcelona, Spain.,Oral Health and Masticatory System Group, Institut D'Investigació Biomédica de Bellvitge (IDIBELL, Bellvitge Institute of Biomedical Research), L'Hospitalet de Llobregrat, Barcelona, Spain
| | - Antonio Marí-Roig
- Oral Health and Masticatory System Group, Institut D'Investigació Biomédica de Bellvitge (IDIBELL, Bellvitge Institute of Biomedical Research), L'Hospitalet de Llobregrat, Barcelona, Spain.,Department of Maxillofacial Surgery, Bellvitge University Hospital, L'Hospitalet de Llobregrat, Barcelona, Spain
| | - Albert Estrugo-Devesa
- Department of Odontoestomatology, Faculty of Medicine and Health Sciences (Dentistry), Bellvitge Campus, University of Barcelona, Barcelona, Spain. .,Oral Health and Masticatory System Group, Institut D'Investigació Biomédica de Bellvitge (IDIBELL, Bellvitge Institute of Biomedical Research), L'Hospitalet de Llobregrat, Barcelona, Spain.
| | - José López-López
- Department of Odontoestomatology, Faculty of Medicine and Health Sciences (Dentistry), Bellvitge Campus, University of Barcelona, Barcelona, Spain. .,Oral Health and Masticatory System Group, Institut D'Investigació Biomédica de Bellvitge (IDIBELL, Bellvitge Institute of Biomedical Research), L'Hospitalet de Llobregrat, Barcelona, Spain. .,Odontology Hospital University of Barcelona (HOUB), Barcelona, Spain.
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Paparella ML, Domingo MG, Puia SA, Jacobi-Gresser E, Olmedo DG. Titanium dental implant-related pathologies: A retrospective histopathological study. Oral Dis 2021; 28:503-512. [PMID: 33544935 DOI: 10.1111/odi.13794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To perform a retrospective, descriptive, histopathological study of peri-implant tissue pathologies associated with titanium dental implants (TDI), and to evaluate the presence of metallic particles in samples from a single diagnostic center. METHODS Sixty-eight cases of TDI-associated lesions were retrieved from the Surgical Pathology Laboratory archives, School of Dentistry, University of Buenos Aires (UBA) (1990-2018). The study included re-examining the histopathological features of the biopsy samples, analyzing the inflammatory infiltrate, and examining the samples to detect metallic particles whose chemical composition was determined spectrophotometrically (EDS). Available clinical and radiographic data were also reviewed. RESULTS The retrieved cases ranged from lesions of inflammatory origin to neoplastic lesions. Metallic particles were observed in 36 cases (52.9%), all of which showed inflammation. Particle length ranged from 2 to 85µm. EDS analysis of the particles/deposits observed in the tissues showed the presence of aluminum, titanium, iron, and nickel, among other elements. CONCLUSIONS A significant number of TDI-associated lesions, including cases not reported to date and diagnosed at a single diagnostic center, are shown here. Cases showing particles exhibited an inflammatory response, irrespective of the histopathological diagnosis. The role of metallic particles in the development of TDI-associated lesion is yet to be established.
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Affiliation(s)
- María Luisa Paparella
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Anatomía Patológica, Buenos Aires, Argentina
| | - Mariela Gisele Domingo
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Anatomía Patológica, Buenos Aires, Argentina.,Research Fellow of the University of Buenos Aires, Buenos Aires, Argentina
| | - Sebastián Ariel Puia
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Cirugía I, Buenos Aires, Argentina
| | | | - Daniel Gustavo Olmedo
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Anatomía Patológica, Buenos Aires, Argentina.,National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina
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