Choosing Juvéderm Volux™ to chin augmentation: Case report and flowchart for clinical evaluation

INTRODUCTION

The development of filler biomaterials with high hyaluronic acid concentrations, cohesiveness, and elastic modulus has become an option for chin augmentation, as the balance of these rheological properties promotes high lifting capacity, providing minimally invasive perceptible improvements in patient appearance.

PRESENTATION OF CASE

The present study reviewed clinical and anatomical aspects of patients referred for chin augmentation and created a flowchart to assertively diagnose patients with an indication of Juvéderm® Volux™ for defining the lower third of the face.

DISCUSSION

The chin is vital for facial proportions and attractiveness perception. Its relevance to facial appearance is noticed the most when chin size is less than ideal, making other facial areas seem larger or smaller. The adjacent soft tissues of the neck and jaw appear prematurely aged when chin projection or width is inadequate. Hyaluronic acid-based fillers have a confirmed history of safe and effective use for treating facial volume loss or deficiency.

CONCLUSION

Juvéderm® Volux™ is a safe, effective, and long-lasting alternative for restoring and creating facial volume and sculpting, shaping, and contouring the chin and jaw.

Influence of photodynamic therapy, different final irrigants, and ultrasonic activation on the bond strength of glass fiber posts to root dentin

OBJECTIVE

To evaluate the influence of photodynamic therapy (PDT), different final irrigants, and ultrasonic activation (US) on the bond strength of glass fiber posts (GFP) to root dentin.

METHODS

One hundred twenty bovine roots were divided into 12 groups according to PDT application, the type of final endodontic irrigant, and US. The samples were divided into 12 groups (n = 10): G1-DW(distilled water); G2-DW+US; G3-17% EDTA; G4-17% EDTA+US; G5-17% GA (glycolic acid); G6-17% GA+US; G7-PDT+DW; G8-PDT+DW+US; G9-PDT+17% EDTA; G10-PDT+17% EDTA+US; G11-PDT+17% GA; G12-PDT+17% GA+US. After cementing the glass fiber posts with resin cement, roots were sectioned into 2-mm-thick slices. One slice from the cervical third and another from the middle third were used for the push out test (PO), and the other two for the diametral compression test (DC). Thus, 10 samples were obtained per third for each mechanical test (n = 10). Kruskal-Wallis and Student-Newman-Keuls tests were used to analyze PO and DC data, and Pearson's correlation test was used to verify the relationship between the variables. Failure patterns were analyzed with chi-square test.

RESULTS

Significant differences were found in the PO test among the experimental groups (p < 0.001; power=1.00). PDT improved bond strength when using EDTA. PDT and US increased bond strength when using GA. Favorable failure patterns occurred more frequently in Group GA+US. There was no correlation between data obtained with PO and DC tests (r = 0.112; p = 0.729).

CONCLUSION

PDT provided the highest bond strength values of GFP to root dentin when associated with GA and US or when associated only with EDTA.

Uncommon case of histoplasmosis with oral manifestation: A case report of diagnosis in a South American patient

Introduction

Histoplasmosis is a systemic fungal disease caused by the H. capsulatum fungus, which is mainly present in feces and guano of birds and bats. This condition manifests in several ways and it is more severe in its disseminated form and in immunosuppressed patients, putting the patient at risk of death if not diagnosed in time.

Case presentation

This report presents the case of a 39-year-old white female patient, a seller of agricultural machinery, with a history of lupus erythematosus, who attended a private dental office complaining of a tongue lesion. The patient reported having been subjected to an incisional biopsy of this lesion and the histopathological examination identified an inflammatory process. Considering the inefficient management of the lesion with intralesional application of corticosteroids, squamous cell carcinoma or granulomatous fungal infection was suspected, and a new biopsy was performed allowing the diagnosis of histoplasmosis already spread to the liver, intestines, and bone marrow. The diagnosed disease led the patient to undergo extensive antifungal treatment, including a period of hospitalization.

Discussion

The diagnosis of histoplasmosis can be delayed due to several factors, mainly due to its diverse clinical presentation between acute, chronic and disseminated forms. However, achieving an early diagnosis for histoplasmosis is very important to maintain the patient's quality of life.

Conclusion

Greater education, information, and awareness about histoplasmosis among health professionals are required for managing these cases, especially in endemic areas to H. capsulatum.

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The diagnosis of histoplasmosis can be challenging, mimicking other diseases.

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Biopsy and histopathological exams are essential for diagnosis of histoplasmosis.

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The dentist plays a fundamental role in diagnosis of oral lesions of histoplasmosis.

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Histoplasmosis affects immunosuppressed individuals and can lead to death.

Orthognathic surgery and orthodontics associated with orofacial harmonization: Case report

Introduction and importance

Orthognathic surgery aims to restore the functional and esthetic standards of the face and non-surgical or minimally invasive procedures have been optimizing the results of facial orthosurgical treatments. This case report aimed to show the use of minimally invasive techniques that, associated with orthognathic surgery, represent a trend in current oral and maxillofacial rehabilitation.

Case presentation

A female patient, 28 years old, white, sought care from the Dentistry team of the São Vicente de Paulo Hospital, in Passo Fundo, Brazil, complaining of mandibular prognathism, anteroposterior maxillary deficiency, dental crowding, malocclusion, functional and esthetic changes that negatively affected her psychosocial interactions and stomatognathic function. The treatment involved orthodontics, orthognathic surgery, and orofacial harmonization with dermal fillers.

Clinical discussion

The multidisciplinarity among the specialties of Oral and Maxillofacial Surgery and Traumatology, Orthodontics, and Orofacial Harmonization add and contribute to the process of planning and implementing the treatment proposed, as well as the prognosis toward patient satisfaction.

Conclusion

The surgical procedure associated with minimally invasive facial harmonization not only corrected the functional complaint of the patient but also played an important role in improving facial harmony, contributing significantly to self-esteem.

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Minimally invasive facial harmonization refines orthognathic surgery techniques.

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The integration of several disciplines helps to improve facial harmony.

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Injectable fillers represent important allies in orthosurgical treatments.

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.

Facial trauma followed by osteomyelitis - Case report

Introduction

Osteomyelitis is an inflammatory-infectious state that may involve trabecular bone, cortical bone, bone marrow and periosteum. The source of the infection may be hematogenic, acquired from an adjoining infectious focus or by direct inoculation into the bone. Its treatment involves antibiotic administration and surgery, but its management remains challenging.

Presentation of case

A 76-year-old male patient with a history of car accident 3 months earlier sought hospital care with nasal fracture and loss of substance in the right frontotemporal region, where a pectoral muscle free graft was performed to reconstruct the facial defect. The grafted region had hyperemic edges, necrotic appearance, purulent discharge and bone exposure in the nasal dorsum. The initial diagnostic hypothesis was an infectious process due to graft rejection, with likely evolution to osteomyelitis. The surgical procedure was performed by a multidisciplinary team and the patient received the antibiotic regimen according to the antibiogram, with hospital discharge after 39 days of hospitalization.

Discussion

Treatment of osteomyelitis requires the combination of antimicrobial therapy and surgery. Despite surgical and chemotherapeutic advances, it is a difficult condition to treat and there is no universally accepted protocol for treatment.

Conclusion

Surgical treatment was essential for stabilization of the condition. Due to the complexity of this type of infection in the craniofacial region, planning and execution must be carried out through a multidisciplinary team.

Foreign body reaction simulating mandibular osteosarcoma-Case report

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Foreign body granulomas may be associated with silicone prostheses.

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Foreign body granulomas can be mistaken for malignant neoplasms.

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Diagnosis of foreign body granuloma needs clinical, imaging and histological analysis.

Introduction

This study aimed to report the case of a foreign body granuloma in a 34-year-old woman, presenting clinical and imaging characteristics, as well as to discuss the association of using alloplastic material for the lesion in question.

Presentation of case

Female patient seeking dental care for a routine treatment. The panoramic radiograph showed the presence of asymptomatic, radiolucent, and multiloculated lesion between teeth 31 and 34. Among the hypotheses diagnosed, central giant cell granuloma and osteosarcoma were suggested. When questioned, the patient denied any health changes or recent local procedures. After performing a histopathological examination and insisting on anamnesis, the case was diagnosed more accurately as "foreign body reaction" and the adequate therapy was determined.

Discussion

The use of alloplastic material has been reported as an etiological factor of foreign body lesions, and dentists, either clinicians, radiologists or pathologists, should be aware of this because of the great increase of such procedures and the difficulties related to their diagnosis.

Conclusion

The foreign body granuloma associated with silicone prosthesis, based on its clinical and imaging characteristics, may be mistaken for neoplastic processes.