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The primordial odontogenic tumor (POT) is a rare mixed odontogenic tumor composed of mesenchymal cells, columnar odontogenic epithelium, and fibromyxoid stroma affecting the posterior mandible of children and adolescents. Herein, we report 3 patients with POT and the clinicopathological features of POT previously reported in the literature. A 12-year-old, 19-year-old, and 4-year-old patient presented an asymptomatic swelling in the posterior maxilla and posterior mandible. Imaging exams revealed radiolucent lesions associated with unerupted teeth. The lesions were surgically removed, and the histopathological examination revealed spindle-to-ovoid mesenchymal cells in a fibromyxoid stroma surfaced by columnar odontogenic epithelial cells with reverse nuclear polarization. Deposition of mineralized tissue was observed. The final diagnosis was POT, and patients did not exhibit signs of recurrence. POT should be included in the differential diagnoses of intraosseous lesions in the posterior mandible in pediatric patients.

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This report describes the unexpected formation of root-like structures following the avulsion of immature permanent teeth without replantation. A 6-year-old female patient had avulsed the four permanent mandibular incisors and the two deciduous mandibular canines. The patient was seen in an emergency healthcare unit but did not receive specialized treatment for tooth replantation. As follow-up treatment, she received a removable prosthesis. After 4 years of follow-up, an image obtained by panoramic radiography showed formations similar to four root structures in the alveolus of the previously avulsed permanent teeth. This finding was confirmed by periapical radiography and computed tomography. This case report demonstrates that in teeth with incomplete root development, even after avulsion without replantation, cells from the pulp stump may have the capacity to form mineralized structures that appear radiographically comparable to root dentin.

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RESUMEN: El objetivo de este artículo es evaluar el éxito clínico de una nueva alternativa para crear papilas en implantes de carga inmediata, que se realizó en una paciente de sexo femenino de 26 años de edad. Se inició el tratamiento con la confección de una guía quirúrgica, previo a la manipulación de los tejidos para crear las papilas peri-implantarias. En la cirugía se realizan 2 incisiones semilunares, unidas por una incisión perpendicular, las que al suturarlas sobre ellas mismas permitió crear las papilas; se instala un implante con buena estabilidad primaria y se toma la impresión para la rehabilitación. A las 24 horas se instala una corona atornillada, mostrando la presencia de las papilas de forma inmediata. Se realiza controles hasta los 20 meses de función, evidenciando buena estabilidad de las papilas mesial y distal sin presentar ningún tipo de complicación.

ABSTRACT: The aim of this paper is to evaluate the clinical success of a new alternative to create papillae in immediate load implants, which was performed in a 26-yearold female patient. The treatment was started with the preparation of a surgical guide, prior to the manipulation of tissues to create the peri-implant papillae. In the surgery, two semilunar incisions are made, joined by a perpendicular incision, which when sutured on them allowed to create the papillae. An implant with good primary stability is installed and the impression is taken for rehabilitation. At 24 h a screwed crown is installed, showing the presence of the papillae immediately. Controls are performed up to 20 months of function, demonstrating good stability of the mesial and distal papillae without presenting any type of complication.

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AIM: The aim this study was to evaluate the factors that influence the presence or absence of the interproximal papilla between implants adjacent to the teeth or other implants, through clinical and radiographic evaluation. MATERIAL AND METHODS: The non-probabilistic sample comprised 44 patients of both genders aged between 21 and 68 years, rehabilitated with 114 osseointegrated implants. Through a retrospective clinical study, the patients were divided according to the presence or absence of the interproximal papilla: Group 1 - Absence of Papilla, Group 2 - Partial Presence of Papilla and Group 3 - Total Presence of Papilla. The success of the implants, the periodontal biotype, and the vertical and horizontal distances of the interproximal regions included in the study were evaluated. RESULTS: Of the 114 implants, 46.5% were considered unsuccessful, and bleeding was present in 29.8%. The periodontal biotype presented as thin and scalloped was found in 85.1% of the regions. The evaluation of the groups according to the confirmation of the interproximal space showed a statistically significant difference (p = 0.007), with 61.9% of the wide and long interproximal spaces classified as Group 1, while 31% of the narrow and short interproximal spaces were classified as Group 3. CONCLUSION: It was concluded that the morphology of the interproximal space was the factor that was most strongly associated with the presence or absence of the interproximal papilla.

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Abstract We previously reported that elevated extracellular calcium (Ca2+) levels increase bone morphogenetic protein 2 expression in human dental pulp (hDP) cells. However, it is unknown whether extracellular Ca2+ affects the expression of other growth factors such as fibroblast growth factor 2 (FGF2). Objective: The present study aimed to examine the effect of extracellular Ca2+ on FGF2 gene expression in hDP and immortalized mouse dental papilla (mDP) cells. Materials and Methods: Cells were stimulated with 10 mM CaCl2 in the presence or absence of cell signaling inhibitors. FGF2 gene expression was assessed using real-time polymerase chain reaction. The phosphorylation status of signaling molecules was examined by Western blotting. Results: Extracellular Ca2+ increased FGF2 gene expression in mDP and hDP cells. Gene expression of the calcium-sensing receptor and G protein-coupled receptor family C group 6 member A, both of which are extracellular Ca2+ sensors, was not detected. Ca2+-mediated Fgf2 expression was reduced by pretreatment with the protein kinase A (PKA) inhibitor H-89 or extracellular signal-regulated kinase (ERK) 1/2 inhibitor PD98059 but not by pretreatment with the protein kinase C inhibitor GF-109203X or p38 inhibitor SB203580. Extracellular Ca2+ increased PKA activity and ERK1/2 phosphorylation. Ca2+-induced PKA activity decreased by pretreatment with PD98059. Conclusions: These findings indicate that elevated extracellular Ca2+ levels led to increased Fgf2 expression through ERK1/2 and PKA in mDP cells and that this mechanism may be useful for designing regenerative therapies for dentin.

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La reconstrucción de la estética gingival (rosada) es un tema importante en la odontología implanto-soportada moderna, y cualquier resultado estético comprometido se considera un fracaso. En la literatura se proponen variados enfoques quirúrgicos y no quirúrgicos para reconstruir la papila interdental perdida. En esta técnica modificada, el extremo distal del injerto pediculado fue dividido en dos partes creando una estructura bífida, que luego se colocó alrededor del pilar y suturó por vestibular. Esta técnica dio como resultado un aumento significativo de volumen de la papila en las direcciones coronaria y vestibular. El injerto de tejido conectivo pediculado subepitelial asociado con un colgajo coronalmente desplazado parece ser un abordaje viable para el tratamiento de la papila ausente, asociado con restauraciones implanto-soportadas.

Rebuilding the pink esthetic is an important issue in modern esthetic implant dentistry, and any compromised esthetic results following implant-supported restorations are considered failures. Several surgical and nonsurgical approaches are proposed in the literature to reconstruct the lost interdental papilla. In this modified technique the distal end of the pedicle graft was divided into two parts creating a bifid, which were then placed around the abutment and sutured on the facial aspect. This technique resulted in a significant gain of papillary volume in both coronal and facial directions. The subepithelial connective pedicle graft associated with a coronally advanced flap seems to be a viable approach for the treatment of missing papilla associated with implant-supported restorations.

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Este artigo procurou enfatizar a importância de se realizar uma adequada avaliação tecidual antes de iniciar reabilitações estéticas, além de sugerir possíveis condutas para restabelecer a arquitetura gengival. No caso clínico apresentado, os incisivos centrais superiores foram tracionados lentamente por aparatologia ortodôntica, visando nivelar o arco gengival e devolver a papila interdental. Após a obtenção de um quadro gengival mais harmônico, a forma dental foi restaurada com facetas cerâmicas para alcançar um bom resultado estético.

This article emphasizes the importance of adequate tissue assessment before starting aesthetic restorations, as well as to suggest possible guidelines to restore the gingival architecture. In the clinical case presented, the upper central incisors were orthodontically extruded, aiming to level the gingival arch and to retrieve the dental papillae. After obtaining a more harmonic gingival architecture, the dental form was restored with ceramic veneers to achieve good aesthetic result.

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A ausência ou perda da papila interdental cria deficiência estética, problemas fonéticos, impactação alimentar e gera muita expectativa ao paciente. Até o momento, o tratamento da ausência ou perda da papila interdental tem sido mal sucedido e não há estudos que indiquem que a regeneração da papila é um resultado previsível. O objetivo deste estudo foi avaliar a efetividade da injeção de gel de ácido hialurônico de origem não animal na redução ou eliminação da deficiência de papila entre dentes naturais comparativamente ao tratamento por meio de enxerto de tecido conjuntivo subepitelial. Foram avaliados neste estudo 20 sítios de 6 pacientes de ambos os sexos, com idade variável de 29 a 62 anos, apresentando deficiência de papila entre dentes naturais, na região anterior superior, em pelo menos dois dentes. Os 20 sítios tratados foram aleatoriamente divididos em dois grupos, de acordo com o tratamento para correção da deficiência de papila por meio de enxerto de tecido conjuntivo subepitelial (grupo controle) ou por meio de injeção de gel de ácido hialurônico (grupo teste). Um examinador único, calibrado, avaliou a distância da ponta da papila ao ponto de contato com auxílio de sonda periodontal milimetrada antes e aos 1, 3 e 6 meses após o tratamento. Além disso, foram investigados, nos sítios tratados, as medidas de profundidade de sondagem, nível de inserção, índice de sangramento do sulco, índice de placa, distância do ponto de contato à crista óssea alveolar, distância da ponta da papila à crista óssea alveolar e largura da papila. Os resultados demonstraram que aos 6 meses de pósoperatório o percentual de mudança na altura da papila foi maior no grupo teste (14,94% ± 21,35%) do que no grupo controle (-1,39% ± 31,46%), entretanto sem diferenças significantes entre os grupos (p> 0.05). Não houve variação estatisticamente significante na largura da papila antes e aos 4 meses após o tratamento nos grupos teste (p= 0.09) e controle (p= 0.16), assim como não houve variação significativa na distância entre a ponta da papila e a crista óssea alveolar. Houve melhora significativa do Índice de Estética Rosa (IER) observado aos 6 meses de acompanhamento em comparação com a condição inicial no grupo teste (p= 0.0078; Wilcoxon), enquanto que não houve mudança significativa no IER observado no grupo controle aos 6 meses de acompanhamento (p= 0.35). Os resultados obtidos permitiram concluir que o tratamento da deficiência de papila por meio de injeção de gel de ácido hialurônico promove melhora da deficiência de papila, similar aos resultados obtidos com o tratamento por meio de enxerto de tecido conjuntivo subepitelial, porém com melhora estética significativa relacionada especialmente às características de cor e textura do tecido relativamente aos tecidos moles adjacentes.(AU)

The absence or loss of interdental papilla creates an esthetic deficiency, phonetic problems and food impaction and generates a lot of expectation for the patient. Until now, the treatment for absence or loss of interdental papilla is unsuccessful e and there are no researches that show that the papilla regeneration is a predictable outcome. The aim of this study was to evaluate the effectivity of a non-animal originated hyaluronic acid injection in the reduction or elimination of papilla deficiency between natural teeth in comparison to a sub epithelial connective tissue graft treatment. The analysis was made on 20 sites in 6 patients, both genders, 29 - 62 years, showing deficiency in the papilla between natural teeth in the upper anterior region in at least two teeth. The 20 sites treated were randomly divided into two groups, according to the treatment by subepithelial connective tissue graft (control group) or by hyaluronic acid injection (test group). A single calibrated examiner evaluated the distance between the tip of the papilla to the contact point using a graduated periodontal probe before the treatment and 1, 3 and 6 months after it. Besides, it were investigated probing pocket depth, clinical attachment level, gingival bleeding index, plaque index, distance from papilla to alveolar crest, distance from contact point to alveolar crest and width of the papilla. The results showed that 6 months after the procedure, the percentage of change in the papilla level was higher in the test group (14,94% ± 21,35%) than in the control group (-1,39% ± 31,46%), though not statistically significant (p>0.05). There was no significant difference variation in the width of the papilla before and 4 months after the treatment in test group (p=0.09) and control group (p=0.16), and there was no significant difference variation in the distance between the tip of the papilla and the alveolar bone crest. There was significant improvement of the Pink Esthetic Score (PES) after 6 months in comparison to the initial condition in test group (p=0.0078; Wilcoxon), while there was no significant difference in the PES in control group 6 months after treatment (p=0.35). The results allow to conclude that the treatment for of the papilla deficiency using hyaluronic acid injection promotes improvement, similar to the results of the sub epithelial connective tissue graft treatment, but with significant esthetic improvement related specially to the color and texture characteristics of the adjacent soft tissues.(AU)

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O mixoma odontogênico compartilha aspectos celulares e estruturais com a papila dentária, tendo-se implicado esta última como provável origem deste neoplasma. O propósito desta pesquisa consistiu em analisar comparativamente a expressão imuno-histoquímica de colagenase-1 (MMP-1) e gelatinases A (MMP-2) e B (MMP-9) em mixomas odontogênicos e papilas de germes dentários. Foram selecionados 12 casos de mixoma odontogênico e 08 espécimes de germes dentários, para análise da presença ou ausência de expressão imunohistoquímica e padrão de distribuição destas proteases em meio à matriz extracelular, bem como, o número de células positivamente marcadas para estas metaloproteinases de matriz (MMPs). Constatou-se diferença significativa (p<0,05) em relação à imunorreatividade para MMP-2, apresentando-se expressa apenas em meio à matriz extracelular dos mixomas. Para MMP-1 foi verificada imunorreatividade na maioria dos casos de mixomas, com proporções semelhantes às constatadas nas papilas dentárias. Em relação ao padrão de distribuição, evidenciou-se diferença significativa apenas para MMP-1 (p<0,05), com predominância do padrão focal nos neoplasmas. Por sua vez, a quantidade de células imunorreativas às proteases, nos mixomas odontogênicos, revelou diferenças significativas (p<0,05), estando a MMP-1 presente em maiores proporções, em comparação com as MMPs-2 e -9. Concluiu-se que a expressão de MMP-1, em nível comparável ao constatado nas papilas de germes dentários e numericamente superior às MMPs-2 e -9, sugere a implicação desta protease no processo de degradação da matriz extracelular nos mixomas odontogênicos e, em decorrência da possibilidade de associação das MMPs a receptores envolvidos no processo de adesão celular, especialmente às integrinas, ainda um provável papel na invasividade local destes neoplasmas. Adicionalmente, a evidenciação de um gradiente descendente na expressão imuno-histoquímica das MMPs nos mixomas odontogênicos, associada à especificidade de substrato inerente a cada uma destas proteases, sugerem a existência de um mecanismo coordenado entre colagenase intersticial e gelatinases A e B, direcionado à degradação eficiente da matriz extracelular e invasão local por parte das células neoplásicas. (AU)

The odontogenic myxoma shares cellular and structural aspects with dental papilla, which has been implicated as probable origin of this neoplasm. The aim of the present study was to perform a comparative immunohistochemical analysis for the expression of collagenase-1 (MMP-1) and gelatinases A (MMP-2) and B (MMP-9) in odontogenic myxomas and dental papilla of teeth germs. Twelve cases of odontogenic myxomas and eight specimens of teeth germs were selected. It was taken into consideration the presence or absence of immunoreactivity, the pattern of immunohistochemical distribution of proteases within extracellular matrix, as well as, the number of cells revealing immunostaining for matrix metalloproteinases (MMPs). It was verified a significant difference (p<0,05) in relation to MMP-2 immunoexpression, which was observed only within extracellular matrix of myxomas. Nevertheless, MMP-1 labeling was revealed by most of the cases of odontogenic myxoma, at levels close to those observed in dental papilla. In relation to the pattern of distribution, a significant difference was obtained between specimens (p<0,05), with neoplasms predominantly exhibiting a focal pattern for MMP-1. The quantitative analysis of neoplastic cells labeled for MMPs denoted a significant difference (p<0,05), demonstrating a higher proportion of MMP-1 in comparison to MMPs-2 and -9. It can be concluded that immunohistochemical expression of MMP-1 at levels comparable to those observed in dental papilla and quantitatively superior in relation to MMPs-2 and -9, suggest an implication of this protease on extracellular matrix degradation of odontogenic myxomas. Moreover, the possibility of interactions with receptors involved in cellular adhesion, particularly with integrins, suggests a plausible function on local invasiveness of such neoplasms. Additionally, the presence of a descent immunoexpression gradient for these MMPs on odontogenic myxomas, associated to substrate specificity inherent in each enzyme, suggest the existence of a coordinated mechanism between interstitial collagenase and gelatinases A and B in order to allow an efficient degradation of extracellular matrix and local invasion by neoplastic cells. (AU)

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Introduction and objective: This paper aims to report a literature review on the anatomy and morphology of the interproximal papilla and present the options of both surgical and nonsurgical treatment for the recovery of interdental papilla. Literature review: The loss of the interdental papilla because of the interproximal bone loss accounts for aesthetic, phonetic and functional problems of patients with periodontal disease. The interproximal tissue reconstruction has been reported in literature through both surgical procedures with the use of subepithelial connective tissue graft, restorative and orthodontic treatment. Conclusion: The etiology of gingival black space is multifactorial, therefore, it is important to diagnose properly the etiological factor to establish an appropriate treatment planing. However, the treatment approaches are not predictable and further studies are necessary to recommend the clinical practices available to date.

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Objetivo: o presente estudo consiste de uma revisãosistemática sobre os estudos com células-tronco dentais eperiodontais, relatando os resultados obtidos nosexperimentos, bem como seu potencial de aplicação naOdontologia. Material e Métodos: a pesquisa bibliográficadeste trabalho foi realizada nos bancos de dados eletrônicos(Pubmed, Science Direct e Scielo), complementada pelabusca manual de artigos referenciados. Resultados: aliteratura consultada mostrou que os tecidos dentais eperiodontais podem ser uma fonte autógena fácil e eficientede células-tronco, com capacidade de expansão e dediferenciação em fibroblastos, cementoblastos eosteoblastos. Entre as células-tronco dentais e periodontais,as células-tronco da polpa de dentes decíduos (SHED) sãoas que apresentam maior potencial de diferenciação celular.Conclusão: existe um grande avanço nos experimentos comcélulas-tronco adultas provenientes de tecidos bucais; o seufácil acesso e o fato de não serem órgãos vitais constituemum atrativo para uso em técnicas da bioengenharia, além dopotencial clínico na regeneração tecidual.

Objective: This study consists on a systematic review ofliterature on dental and periodontal stem cells. Resultsobtained from the experiments are reported as well as thepotential application of stem cells in Dentistry. Material andMethods: literature search was performed in electronicdatabases (Pubmed, Science Direct and Scielo), togetherwith manual search of references from retrieved articles.Results: literature shows that dental and periodontal tissuesmay be easy and efficient autologous sources of stem cells,which are capable of expansion and differentiation intofibroblasts, cementoblasts and osteoblasts. Among the dentaland periodontal stem cells, the ones from deciduous teethpulp (SHED) are considered to have the highest potential fordifferentiation. Conclusion: there is a great progress inexperiments with adult stem cells derived from oral tissues;their easy access and the fact that those are not vital organsare attractive for using them in bioengineering techniques, inaddition to their clinical potential for tissue regeneration.

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La sonrisa y específicamente los dientes hacen parte de un rostro atractivo. La presencia de diastemas es una de las quejas estéticas más comunes entre los pacientes. Es responsabilidad del odontólogo ofrecer la técnica más apropiada para resolver esos espacios indeseados. La prioridad para el tratamiento de diastemas es la creación del punto de contacto sin perjudicar la anatomía armónica de los dientes involucrados para conseguir la formación de la papila interdental. La utilización de resinas compuestas directas es una opción estética y funcional para tratar tejido sano de forma mínimamente invasiva. El objetivo de este reporte de caso clínico es describir detalladamente el cierre de diastema utilizando restauraciones directas adhesivas.

The smile and specially the teeth are important for an attractive face. The presence of diastema is the most common esthetic complain among patients. It is responsibility of the dentist to offer the best treatment to solve these undesirable spaces. The priority for the diastema treatment is to create a contact point without interfering in the harmonic shape of the teeth involved to achieve the formation of the dental papilla. The use of direct composite resins is an esthetic and functional option to treat intact tissue with a minimum intervention. The purpose of this case report is to describe in details the diastema closure using direct resin composite restoration.

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A papila interdental e o comportamento dos tecidos moles peri-implantares são considerados um ponto crítico para o sucesso estético em osseointegração e geralmente apresenta-se como um desafio clínico. O presente artigo tem o objetivo de revisar as classificações propostas na literatura em relação ao comportamento do tecido gengival e perimplantar. Foi realizada uma pesquisa no banco de dados Medline entre 1985 a 2005, tendo sido selecionados 8 artigos. Os métodos foram aplicados e comparados destacando suas vantagens e desvantagens no uso clínico. Os métodos descritos são específicos e com finalidades distintas. Os métodos são eficazes, visto que todos possibilitam uma medida fácil e prática dos tecidos, podendo comparar o início e o fim do tratamento, além de uma melhor comunicação entre os clínicos.

The interdental papilla and the behavior of soft peri-implant tissues are considered a critical point for the aesthetic success in osseointegration and generally it is presented as a clinical challenge. The present article has the objective to revise the classifications proposals in literature in relation to the behavior of the gingival and to peri-implant tissues. A Medline research was made between 1985 and 2005, and 8 articles were selected. All the methods had been evaluated through a comparative analysis detaching its advantages and disadvantages in the clinical use. The methods described are specific with different purposes. All the methods are efficient (for distinct ends) when are carried through correctly, since all make possible an easy and practical measure of papilla, being able to compare the beginning and end of the treatment beyond one better communication between the clinical.

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