Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology

Editors

2010-04-01

Translation of the Scientific Method … Peer Review

William C. Scarfe — 2010-02-22

In a recent e-mail exchange with a colleague, my attention was drawn to an interesting Website (www. Langenberg.com). Part of the site provides a list of idioms referred to as Langenberg's Laws that essentially pertain to business practices. At the time of writing, there were 91 such “Laws,” with the 100th already reserved. Many seem hauntingly familiar (eg, “To err is human, and some people are more human than others” - Langenberg's 80th Law). Reflecting on my appointment to Section Editor from a 2-year tenure as Associate Editor, I was particularly struck with Langenberg's 5th Law: “If you want quality in the top 5% you have to filter through 20, and say no to the bottom 19.” So for this, my first editorial, I thought it appropriate to present prospective authors, readers, and referees my perspective on the role of specific constituents in the Peer Review Process.

Oropharyngeal candidiasis in the era of antiretroviral therapy

2010-02-16

Oropharyngeal candidiasis (OPC) remains a common problem in the HIV-infected population despite the availability of antiretroviral therapy (ART). Although Candida albicans is the most frequently implicated pathogen, other Candida species also may cause infection. The emergence of antifungal resistance within these causative yeasts, especially in patients with recurrent oropharyngeal infection or with long-term use of antifungal therapies, requires a working knowledge of alternative antifungal agents. Identification of the infecting organism and antifungal susceptibility testing enhances the ability of clinicians to prescribe appropriate antifungal therapy. Characterization of the responsible mechanisms has improved our understanding of the development of antifungal resistance and could enhance the management of these infections. Immune reconstitution has been shown to reduce rates of OPC, but few studies have evaluated the current impact of ART on the epidemiology of OPC and antifungal resistance in these patients. Preliminary results from an ongoing clinical study showed that in patients with advanced AIDS, oral yeast colonization was extensive, occurring in 81.1% of the 122 patients studied, and symptomatic infection occurred in one-third. In addition, resistant yeasts were still common, occurring in 25.3% of patients colonized with yeasts or with symptomatic infection. Thus, OPC remains a significant infection in advanced AIDS, even with ART. Current knowledge of the epidemiology, pathogenesis, clinical presentation, treatment, and mechanisms of antifungal resistance observed in OPC are important in managing patients with this infection and are the focus of this review.

Development of a novel bone grafting material using autogenous teeth

2010-01-11

We developed a novel bone grafting material that incorporates autogenous teeth (AutoBT), and provided the basis for its clinical application. AutoBT contains organic and inorganic mineral components and is prepared from autogenous grafting material, thus eliminating the risk of an immune reaction that may lead to rejection. AutoBT was used at the time of implant placement, simultaneously with osteoinduction surgery, and excellent bony healing by osteoinduction and osteoconduction was confirmed.

Comparison of the modified lateral orbitotomy approach and modified hemicoronal approach in the treatment of unstable malunions of zygomatic complex fractures

Viraj R. Kharkar, B.M. Rudagi, Rajshekhar Halli, Yogesh Kini — 2010-01-25

Objective: The objective of this study was to evaluate immediate and late postoperative complications in treating zygomatic complex fractures by 2 modified approaches; namely, the modified lateral orbitotomy approach and the modified hemicoronal approach.Study design: Twenty zygomatic complex fractures were treated, with 10 being treated with the modified lateral orbitotomy approach and the other 10 by the modified hemicoronal approach. Both groups were evaluated for postoperative complications, ie, hematoma, infection, swelling, and nerve injury. The incisions were also evaluated in all patients using clinical evaluation and visual analogue scales.Results: Patients in both groups had temporary facial nerve injury that was primarily related to retraction of the nerve. There were no hematomas observed in any of the groups. As compared to the modified lateral orbitotomy approach, swelling was observed on more occasions with the modified hemicoronal approach. Infection was not observed in any of the groups. As far as the esthetics in relation to the incision was concerned, the patients accepted the modified hemicoronal approach more strongly as compared with the modified lateral orbitotomy approach.Conclusion: The modified hemicoronal approach seems to be preferred to the modified lateral orbitotomy approach with respect to treating zygomatic complex fractures.

Functional endoscopic sinus surgery as an adjunctive treatment for closure of oroantral fistulae: a retrospective analysis

2010-02-16

Objective: The objective of this study was to report results of functional endoscopic sinus surgery (FESS) for treatment of chronic maxillary sinusitis of dental origin in a series of patients with oroantral fistulae (OAF).Study design: Fourteen patients were treated by FESS and OAF closure by local flap. Data on severity of symptoms, diagnostic endoscopy, and coronal CT scan findings, as well as intraoperative course and complications, were recorded. The follow-up period lasted up to 2 years, comprising clinical examinations and control CT scans.Results: All OAF healed uneventfully. All patients reported improvement in severity of sinusitis symptoms, which was confirmed through results of clinical examinations and control CT scans. No significant complications were recorded. No revision surgery was needed in any case.Conclusion: These results indicate that FESS, combined with OAF closure by buccal flap, might be an effective and safe option for treatment of selected cases of chronic odontogenic sinusitis with OAF.

Resection and immediate reconstruction of a pediatric vascular malformation in the mandible: Case report

Jonathan W. Shum, Lewis Clayman — 2010-01-25

Arteriovenous malformations (AVMs) within the mandible are rare and potentially life-threatening conditions that can pose a therapeutic dilemma. We present the case of a child with significant spontaneous gingival bleeding, radiographic evidence of a space-occupying lesion of the mandible, and delayed diagnosis and treatment because of parental reluctance to accept invasive treatment. Imaging studies and intravascular embolization with coils limited, but did not stop blood flow to this lesion. Resection of the mandible was the definitive treatment. The AVM was removed from the resected segment and the bone was replaced as a free graft, thereby avoiding a second site morbidity. Two years after surgery the replaced segment was well consolidated with moderate vertical resorption-remodeling.

Effects of soft tissue punch size on the healing of peri-implant tissue in flapless implant surgery

2009-11-19

Objective: In an attempt to help produce guidelines for the use of soft tissue punches, this animal study was undertaken to examine the effects of soft tissue punch size on the healing of peri-implant tissue in a canine mandible model.Study design: Bilateral, edentulous, flat alveolar ridges were created in the mandibles of 6 mongrel dogs. After a 3-month healing period, 3 fixtures (diameter 4.0 mm) were placed on each side of the mandible using 3-mm, 4-mm, or 5-mm soft tissue punches. After subsequent healing periods of 3 weeks and 3 months, the peri-implant mucosa was evaluated using clinical, radiologic, and histometric parameters, which included gingival index, bleeding on probing, probing pocket depth, marginal bone loss, and vertical dimension measurements of the peri-implant tissues.Results: The results obtained showed significant differences (P < .05) between the 3-mm, 4-mm, and 5-mm tissue punch groups for the length of the junctional epithelium, probing depth, and marginal bone loss at both 3 weeks and 3 months after implant placement. When the mucosa was punched with a 3-mm tissue punch, the length of the junctional epithelium was shorter, the probing depth was shallower, and less crestal bone loss occurred than when using a tissue punch with a diameter ≥4 mm.Conclusions: The results show that the size of the soft tissue punch plays an important role in achieving optimal healing. The findings support the use of a tissue punch slightly narrower than the implant itself to obtain better peri-implant tissue healing around flapless implants.

Comparison of the osteoinductivity of bioimplants containing recombinant human bone morphogenetic proteins 2 (Infuse) and 7 (OP-1)

2010-03-02

Objectives: Recent research has focused on application of growth factors such as bone morphogenetic proteins (BMPs) as alternatives to autogenous bone grafting. Two bone graft substitute bioimplants containing recombinant human BMPs (rhBMPs), Infuse (rhBMP-2) and OP-1 (rhBMP-7), are approved for human application but have never been compared side by side. The aim of this study was to provide a direct comparison of the osteoinductive activity of the 2 commercially available and approved rhBMP-containing bioimplants in their clinically available forms.Study design: The activity of rhBMP-2 and -7 in solution were compared in vitro using the C2C12 cell-based assay. The activity of Infuse and OP-1 bioimplants containing 52.5 μg of rhBMP-2 or rhBMP-7, respectively, were compared in vivo using a mouse muscle pouch assay and analyzed by microscopic CT (microCT) and histology.Results: The in vitro results showed that rhBMP-2 stimulated greater alkaline phosphatase production than rhBMP-7 over various time points and concentrations. The in vivo results showed that OP-1 induced greater bone volume than Infuse. Both implants induced bone of equivalent quality based on microCT and histologic evaluation.Conclusion: In their clinically available forms, the rhBMP-7–containing OP-1 induced greater bone volume than the rhBMP-2–containing Infuse in the mouse muscle pouch model.

Clinical and radiographic outcomes of implants immediately placed in fresh extraction sockets

Bilge Gökçen-Röhlig, Uğur Meriç, Haluk Keskin — 2010-04-01

Objective: The objective of this study was to examine the clinical and radiographic results of implants placed in fresh extraction sockets for 2 years of function.Study design: Ten patients were presented a treatment protocol involving the extraction of their remaining mandibular teeth and immediate placement of 4 implants (2 in fresh extraction sockets; test group (TG, n = 20), 2 in mature bone; control group (CG, n = 20). Descriptive statistics for the differences between baseline and follow-up values were assessed by chi-square test.Results: None of the implants lost osseointegration. The MPI Score 0 was 80.3% in SG, 82.7% in CG, and MPI Score 1 was 13.4% in SG and 14.9% in CG at the end of 1 year, and remained stable after 2 years. No significant difference in MPI, MBI, KMW, and PPD were observed between the baseline examination and controls. Chances in MBL in CG were slightly higher in SG.Conclusion: Placement of implants in fresh extraction sockets is a reliable treatment alternative.

Effects of intra-articular administration of sodium hyaluronate on plasminogen activator system in temporomandibular joints with osteoarthritis

2010-02-25

Objective: The aim of this study was to investigate the effect of intra-articular sodium hyaluronate (SH) injections on the main components of plasminogen activator (PA) system in the synovial fluid of temporomandibular joint (TMJ) osteoarthritis (OA).Study design: Forty patients diagnosed with TMJ OA and 20 healthy control subjects were included in this study. Synovial fluid was collected in the OA group and the healthy group at baseline. The OA patients were randomly divided into 2 groups (20 patients for each group): One group received 5 injections of SH, and the other received 5 injections of physiologic saline solution in the upper joint space at weekly intervals. Synovial fluid was collected before and after treatment. Urokinase-type PA (uPA), soluble uPA receptor (suPAR) and PA inhibitor 1 (PAI-1) levels in synovial fluid were quantified by enzyme-linked immunosorbent assay.Results: The OA patients had significantly higher uPA activity and levels of uPA (median 80.01 ng/L), suPAR (median 7.54 ng/L), and PAI-1 (median 54.9 ng/mL) than the healthy control subjects (median 20.47 ng/L uPA, 2.34 ng/L suPAR, and 19.9 ng/mL PAI-1; (P < .05). The uPA activity and levels of uPA, suPAR, and PAI-1 were significantly decreased after SH injections in TMJs of OA patients (P < .05), and there was no difference after saline injection. Visual analog pain score reduction correlated with changes in uPA and uPAR levels as well as uPA activity.Conclusion: The effects of SH on PA system provide new insight into a possible underlying mechanism by which SH alleviates pain of patients with TMJ OA.

T−786C polymorphism of the endothelial nitric oxide synthase gene and neuralgia-inducing cavitational osteonecrosis of the jaws

2010-02-25

Objective: We hypothesized that, similar to idiopathic hip osteonecrosis, the T−786C mutation of the endothelial nitric oxide synthase (eNOS) gene affecting nitric oxide (NO) production was associated with neuralgia-inducing cavitational osteonecrosis of the jaws (NICO).Design: In 22 NICO patients, not having taken bisphosphonates, mutations affecting NO production (eNOS T−786C, stromelysin 5A6A) were measured by polymerase chain reaction. Two healthy normal control subjects were matched per case by race and gender.Results: Homozygosity for the mutant eNOS allele (TT) was present in 6 out of 22 patients (27%) with NICO compared with 0 out of 44 (0%) race and gender–matched control subjects; heterozygosity (TC) was present in 8 patients (36%) versus 15 control subjects (34%); and the wild-type normal genotype (CC) was present in 9 patients (36%) versus 29 controls (66%) (P = .0008). The mutant eNOS T−786C allele was more common in cases (20 out of 44 [45%]) than in control subjects (15 out of 88 [17%]) (P = .0005). The distribution of the stromelysin 5A6A genotype in cases did not differ from control subjects (P = .13).Conclusions: The eNOS T−786C polymorphism affecting NO production is associated with NICO, may contribute to the pathogenesis of NICO, and may open therapeutic medical approaches to treatment of NICO through provision of L-arginine, the amino-acid precursor of NO.

Molecular methodology to assess the impact of cancer chemotherapy on the oral bacterial flora: a pilot study

2010-04-01

Objective: This pilot study determined the profile of the oral bacterial flora in an outpatient cancer population before and after chemotherapy using molecular techniques.Study design: We recruited 9 newly diagnosed breast cancer patients scheduled for induction chemotherapy. All were seen immediately before chemotherapy, and 7 to 14 days later. At both visits, we performed oral evaluations and obtained mucositis grading (with the World Health Organization [WHO] scale), absolute neutrophil counts (ANC), and bacterial samples from the buccal mucosa. Bacterial DNA was isolated, and 16S ribosomal RNA gene clonal libraries were constructed. Sequences of genes in the library were used to determine species identity by comparison to known sequences.Results: After chemotherapy, WHO scores of 0 and 1 were in 3 and 6 patients, respectively, and mean ANC (±SD) dropped from 3326 ± 463 to 1091 ± 1082 cells/mm3. From pre- and post-chemotherapy samples, 41 species were detected, with a predominance of Gemella haemolysans and Streptococcus mitis. More than 85% of species have not been previously identified in chemotherapy patients. Seven species appeared exclusively before chemotherapy and 25 after chemotherapy. After chemotherapy, the number of species per patient increased by a mean of 2.6 (SD = 4.7, P = .052).Conclusion: We identified species not previously identified in chemotherapy patients. Our results suggest a shift to a more complex oral bacterial profile in patients undergoing cancer chemotherapy.

Evaluation of penicillin G potassium troches in the treatment of minor recurrent aphthous ulceration in a Chinese cohort: a randomized, double-blinded, placebo and no-treatment–controlled, multicenter clinical trial

2010-03-02

Objective: The aim of this study was to explore the effectiveness and safety of topical application of 50 mg penicillin G potassium troches in the treatment of minor recurrent aphthous ulcerations (MiRAU) in a Chinese cohort.Material and methods: A randomized, double-blinded, placebo and no-treatment–controlled, multicenter clinical trial was performed. Troches were consecutively applied 4 times per day for 4 days. The size and pain level of ulcers were measured and recorded on days 0, 3, 4, 5, and 6.Results: A total of 258 subjects with minor recurrent aphthous ulcerations (86 subjects in penicillin G potassium group, 88 subjects in placebo control group, and 84 subjects in no-treatment control group) fulfilled the study. Penicillin G potassium significantly reduced ulcer size (P < .00001 for days 3, 4, 5, and 6) and alleviated ulcer pain (P < .00001 for days 3, 4, 5, and 6). No severe adverse reactions were observed. Only 4 subjects experienced mild adverse reaction.Conclusions: Penicillin G potassium troches are effective in reducing ulcer size and alleviating ulcer pain of the patients in the treatment of a single episode of MiRAU in this Chinese cohort. Few adverse effects were observed with this therapeutic approach.

Neuropathic orofacial pain after dental implant placement: review of the literature and case report

2010-04-01

Persistent and chronic pain is more common in the head and neck region than in any other part of the body; therefore, dentists are more likely to encounter these rather complex cases in their practices. In this report, we present a brief review of neuropathic orofacial pain (NOP) that can begin after deafferentation of trigeminal nerve fibers after root canal treatment, apicoectomy, tooth extraction, or implant placement or idiopathically. A case of NOP occurring after a surgical implant procedure in a 62-year-old woman is presented. Continuous pain started 6 months after the placement of 8 dental implants in the maxilla, at the time of positioning the prosthesis on her implants. After being subjected to a physical examination and relevant complementary radiologic imaging, the patient was diagnosed with an NOP secondary to nerve impingement due to dental implant placement as well as myofascial head and neck pain.

Long-term treatment of Langerhans cell histiocytosis of the mandibular condyle with indomethacin

Ji Woon Park, Jin Woo Chung — 2010-04-01

Langerhans cell histiocytosis (LCH) most commonly occurs as a localized solitary bone lesion and appears predominantly in pediatric patients. LCH is characterized by the proliferation and accumulation of Langerhans cells which may cause pain and adjacent soft-tissue swelling. This disease is of clinical importance to dental professionals because LCH commonly involves the oral and maxillofacial region and early symptoms can be manifested in the jaw and, when overlooked, may result in extensive destruction of the involved structures. Considering the fact that this is a relatively rare entity, close investigation of the cases that are encountered are warranted. Herein we report a case of LCH occurring in the left condyle of an 11-year-old boy that initially showed clinical symptoms mimicking an abscess of the temporomandibular joint. The clinical and radiographic features, differential diagnosis, treatment, and long-term follow-up of this patient with indomethacin are presented.

Cystic lymphoid hyperplasia of the parotid gland in HIV-positive and HIV-negative patients: quantitative immunopathology

Friederike H. Kreisel, John L. Frater, Anjum Hassan, Samir K. El-Mofty — 2010-04-01

Background: Benign lymphoepithelial lesions of the parotid include a spectrum of disorders ranging from lymphoepithelial sialadenitis (LESA) of Sjögren syndrome to lymphoepithelial cysts (LEC) and both human immunodeficiency virus (HIV)–related and –unrelated cystic lymphoid hyperplasia (CLH). They share a common microscopic appearance characterized by epimyoepithelial islands and/or epithelial lined cysts in a lymphoid stroma. However, they differ greatly regarding their etiology, clinical presentation, and management.Objective: The purpose of this study was to establish specific immunophenotypic profiles for these diverse disease entities.Study design: Four cases of HIV+ CLH, 5 cases of HIV− CLH, 3 cases of LESA of Sjögren syndrome, and 3 cases of sporadic LEC were quantitatively analyzed for distribution of lymphoreticular cell subpopulations, using antibodies against CD20, CD45RO, CD4, CD8, CD57, and CD68.Results: The cystic lesions in both the HIV+ and HIV− cases were microscopically analogous. However, a marked decrease in the interfollicular CD4:CD8 ratio was observed in all HIV+ CLH cases, which was statistically significant when compared with the HIV− cases (P = .02) and cases of LESA of Sjögren syndrome (P = .03). No significant differences regarding the distribution of CD20+ B lymphocytes in epithelial cyst lining or the interfollicular or follicular distribution of CD20+, CD45RO+, CD57+, and CD68+ cells were present among the different groups.Conclusion: Analysis of the interfollicular CD4:CD8 ratio may offer a simple immunophenotypic approach in the distinction of HIV+ from other lymphoepithelial lesions of the parotid gland, when HIV status is unknown and p24 immunohistochemistry is not readily available.

Survivin as a potential early marker in the carcinogenesis of oral submucous fibrosis

2010-04-01

Objective: Oral submucous fibrosis (OSF) is a chronic precancerous condition. Survivin is one of the inhibitors of apoptosis protein, and is focused on owing to its unique therapeutic and prognostic potential.Study design: To determine the potential involvement of survivin in the carcinogenesis of OSF, we analyzed the relationship between the survivin and clinical characteristic.Results: Immunohistochemistry was used to show that survivin expression levels were significantly higher in the oral squamous cell carcinoma transformed from OSF group compared with normal group (P < .01) and OSF group (P < .01). In the different stages of OSF, survivin expression exhibited difference as well. Furthermore, Western blotting and reverse-transcription polymerase chain reaction analysis confirmed the increased expression of survivin in the carcinogenesis of OSF.Conclusion: These results suggest that survivin plays an important role during the malignant transformation of OSF and may provide an indication to early prevention and diagnosis in the progression of OSF.

Metastases in odontogenic cysts: literature review and case presentation

2010-04-01

Malignant tumors in the oral cavity are relatively rare. About 5% of all malignant growths in the body are localized in the oral cavity. The vast majority of oral malignancies are primary tumors with squamous cell carcinoma being the most frequent and sarcomas occurring very seldom. Secondary tumors caused by hematogenous spread arising from a tumor localized elsewhere in the body are extremely rare. About 1% of all oral cancers are metastases to the jawbones and the surrounding soft tissues. Metastases to the jaws are mainly caused by malignant tumors of the breast, lung, kidney, bone, and colon. They occur in the late state of the disease and are regularly detected by staging examinations including scintigraphy. Even more rare are metastases into odontogenic cysts. Odontogenic cysts include dentigerous cysts, periapical or radicular cysts, and the keratocysts—nowadays declared as keratocystic odontogenic tumor. The incidence of odontogenic cysts is about 10% to 15% of all oral biopsies and therefore general dentists are frequently faced with these types of lesions. The aim of this study was to review the literature regarding metastasis into odontogenic cysts and to further highlight this rare entity with the help of a clinical case.

Oral metastasis of alveolar soft-part sarcoma: a case report and review of literature

2010-04-01

Alveolar soft-part sarcoma (ASPS) is a rare malignant neoplasm with uncertain histogenesis and with a distinctive morphology. It has been described in the oral cavity, but this is the first report of ASPS metastasizing to the maxillary tuber region. A 27-year-old male patient, who was under chemotherapy treatment for ASPS of the thigh, presented in our dental clinic with a painless and pedunculated nodule on the right tuber maxillae. The nodule was erythematous with smooth and lobular surface, measuring 3 cm in maximum diameter. An incisional biopsy was performed and the diagnosis of metastatic ASPS was made. Histologically, the tumor was characterized by a proliferation of polyhedral cells in pseudoalveolar pattern. Tumor cells were large, showing granular cytoplasm, periodic acid–Schiff positive diastase-resistant intracytoplasmic material, and vesicular nuclei with prominent nucleoli. Unfortunately, the patient died 2 months after the diagnosis of the oral metastasis. Metastases of ASPS to the mouth are very rare and indicate a poor prognosis.

Metastatic renal cell carcinoma to the oral cavity and clear cell mucoepidermoid carcinoma: comparative clinicopathologic and immunohistochemical study

2010-04-01

Background: Metastatic clear cell renal cell carcinoma (CCRCC) should be considered in differential diagnosis of intraoral clear cell tumors, including mucoepidermoid carcinoma (MEC).Objective and study design: We compared the clinical, histologic, histochemical, and immunohistochemical characteristics of 9 oral metastatic CCRCCs and 8 intraoral clear cell MECs.Results: Oral metastatic CCRCC affected salivary-gland containing tissues in 7 cases (78%). Microscopically, oral metastasis revealed a proliferation of neoplastic clear cells arranged in an alveolar pattern with central blood vessels, features that were not seen in any intraoral clear cell MEC. Mucicarmine staining was positive only in clear cell MEC. Immunohistochemistry showed similarities in cytokeratin expression; vimentin and CD10 were expressed in all oral metastatic CCRCCs but in only 1 clear cell MEC each.Conclusions: Besides clinical history, the alveolar pattern, vessel distribution, absence of mucicarmine staining, and vimentin and CD10 immunoexpression are useful in histologic differential diagnosis of CCRCC and clear cell MEC.

A salivary gland adenocarcinoma mimicking a microcystic adnexal carcinoma

John R. Basile, Yi-Ling Lin — 2010-04-01

The microcystic adnexal carcinoma (MAC) is a rare, slow-growing but locally aggressive neoplasm arising in the midface and lips of middle-aged adults. The MAC is histologically characterized by deeply infiltrating nests and islands of basaloid or squamous cells forming cysts and ductal structures, proliferating in a dense sclerotic stroma and occasionally exhibiting perineural invasion. We describe a salivary gland adenocarcinoma arising in the lower lip, characterized by ductal structures and cords, 3-5 cell layers in thickness, set in a dense fibrous stroma and also invading nerves, thus mimicking a MAC in both its clinical and its histopathologic appearance. The diagnostic dilemma presented by this lesion is discussed, along with a differential diagnosis and brief review of the literature.

A case of primary combined neuroendocrine carcinoma with squamous cell carcinoma in the upper gingiva

2010-04-01

Neuroendocrine carcinoma is a rare neoplasm that occurs widely in various organs and tissues. The biological behavior of this tumor in the oral region remains poorly understood. We encountered an extremely rare case of combined neuroendocrine carcinoma with squamous cell carcinoma, occurring at the buccal gingiva in a 62-year-old woman. Left partial maxillectomy was performed. Histological examinations revealed solid nests with extensive necrosis and nuclear palisading at the periphery. The tumor also showed areas of stratified neoplastic squamous differentiation. Immunohistochemically, tumor nests stained positive for synaptophysin, chromogranin, N-CAM (CD56), and neuron-specific enolase. Strong positivity was seen for K14 and K17 in the squamous component and for K7 in the neuroendocrine component. Both components showed K19 staining. Cells with squamous differentiation and K14 staining occasionally expressed p63. The patient showed no evidence of disease as of 23 months postoperatively. Given the aggressive characteristics of neuroendocrine carcinoma, strict follow-up has been performed.

Calcifying odontogenic cyst with odontogenic keratocyst: a case report and review of the literature

John R. Basile, Carrie Klene, Yi-Ling Lin — 2010-04-01

The calcifying odontogenic cyst (COC), first identified as a separate and distinct lesion by Gorlin et al. in 1962, is an uncommon benign lesion, consisting of a proliferation of odontogenic epithelium and scattered nests of ghost cells and calcifications that may form the lining of a cyst or present as a solid mass. The COC occurs alone or occasionally with odontomas or other odontogenic tumors, and it is this variable histology and clinical behavior that has raised the question of whether or not it is a cyst or a true neoplasm. The odontogenic keratocyst (OKC) is a locally aggressive odontogenic cyst lined by parakeratinizing epithelium that also exhibits characteristics of a neoplasm, including rapid growth, a high rate of recurrence when treated conservatively, and the presence of a gene mutation. We describe a patient diagnosed with an OKC of the mandible that arose simultaneously with a COC of the anterior maxilla. The occurrence of 2 “cystic neoplasms” in the same patient is an occurrence which to our knowledge has not been previously reported. We discuss the significance of the case and review the current literature regarding these lesions.

Prediction of dental implant torque with a fast and automatic finite element analysis: a pilot study

Thibaut Bardyn, Philippe Gédet, Wock Hallermann, Philippe Büchler — 2010-02-17

Objectives: Despite its importance, implant removal torque can be assessed at present only after implantation. This paper presents a new technique to help clinicians preoperatively evaluate implant stability.Study design: Planning software has been combined with an in-house finite element solver. Once the clinician has chosen the implant position on the planner, a finite element analysis automatically calculates the primary stability. The process was designed to be as simple and fast as possible for clinical use. This paper describes application of the method to the prediction of removal torque. A preliminary validation has been performed in both polyurethane foam and sheep bone.Results: The predicted torque is quantitatively equivalent to experimental values with correlation coefficients of >0.7 in both materials.Conclusions: This preliminary study is a first step toward the introduction of finite element models in computer-assisted surgery. The fact that the process is fast and automatic makes it suitable for a clinical use.

Density measurements of dentin by dual-energy radiography

2010-03-02

Objectives: The aim of this study was to apply the dual-energy radiographic technique to teeth and to soft tissue simulated with Lucite and report the visual and quantitative results.Study design: High- and low-energy image pairs were exposed of aluminum and Lucite calibration wedges and human teeth sections. Reconstructed images of the calibration wedges and teeth sections were viewed and measured.Results: The aluminum reconstruction images accentuated the aluminum wedge and the teeth, whereas the Lucite reconstruction images minimized them. Correlations between the nominal direct and dual-energy measurements of the wedges and teeth thicknesses were found to be very good. The root-mean-square deviation of the dual-energy reconstructions from the measured nominal thicknesses was found to be no greater than 0.6 mm.Conclusion: These results demonstrate the feasibility of using dual energy as a means of selective cancellation of unwanted tissues and the measurement of posterior tooth density.

Radiographic quantification of chronic dental infection and its relationship to the atherosclerotic process in the carotid arteries

Arthur H. Friedlander, Eric C. Sung, Evelyn M. Chung, Neal R. Garrett — 2010-01-25

Background: Atherosclerosis may be initiated/accelerated by chronic dental infection (CDI). Noninvasively visualizing the carotid arteries is an accepted surrogate marker for determining coronary artery atherosclerosis (CAA). We hypothesized that 36 individuals with radiographic carotid atheromas would have more radiographic CDI than risk-matched individuals without atheromas.Methods: We determined the arithmetic sum of individuals' periapical and furcal lesions, pericoronitis sites, carious roots, teeth with pulpal caries, and vertical bony defects (>4 mm).Results: Individuals with atheromas had a significantly (P < .01) greater mean score of 15.5 ± 10.4 compared with control subjects (7.9 ± 8.1). Similarly significant (P < .05) was the difference in the mean numbers of mesial and distal vertical bony defects in the atheroma group (4.1 ± 3.9 and 4.8 ± 3.8, respectively) compared with control subjects (1.6 ± 2.4 and 1.8 ± 2.7, respectively).Conclusions: Individuals with atheromas on their radiographs (and high probability of CAA) had significantly greater amounts of CDI than individuals without atheromas.

Canine transmigration: comprehensive literature review and report of 4 new Australian cases

Julijana Vuchkova, Camile S. Farah — 2010-04-01

Canine transmigration is a rare dental anomaly unique to the mandibular arch, involving intraosseous migration of the unerupted tooth across the midline. Currently, there is a lack of consensus on the definition of transmigration. This report suggests a unified definition of transmigration, that being when a canine has crossed the midline by more than half its length. Numerous publications reporting mandibular canine transmigration therefore cannot be considered as being truly transmigrated. Here we undertake a comprehensive review of the literature, and report 4 new cases of transmigrated mandibular canines, 2 of which present with unique features. One case shows a vertically positioned transmigrated canine, whereas the other shows a horizontally transmigrated canine underlying an impacted canine. Furthermore, this cohort is the first to be reported in an Australian population.

Carotid body paraganglioma manifesting as a malignant solitary mass on imaging: a case report

2010-04-01

A 58-year-old woman presented with a lump on the left side of the neck. Investigations by ultrasound-guided fine needle aspiration, magnetic resonance imaging, and positron emission tomography were all indicative of a diagnosis of a solitary malignant mass with no primary lesion identified. The patient underwent a level I-V leftside selective neck dissection. The histology reulsts reported the mass as a carotid body paraganglioma. These are highly vascular lesions. Paragangliomas have characteristic features on the differend imaging modalities; in this case they were atypical. This article reviews the main imaging modalities of paragangliomas and cytologic findings of the fine needle aspiration, which is not often performed for these cases owing to their high vascularity.

A comparison of nickel-titanium rotary instruments manufactured using different methods and cross-sectional areas: ability to resist cyclic fatigue

2010-04-01

Objective: This study examined the effect of the manufacturing methods (ground, electropolished, and twisted) and the cross-sectional area (CSA) of nickel-titanium (NiTi) rotary instruments on their cyclic fatigue resistance.Study design: A total of 80 NiTi rotary instruments (ISO 25/.06 taper) from 4 brands (K3, ProFile, RaCe, and TF) were rotated in a simulated root canal with pecking motion until fracture. The number of cycles to failure (NCF) was calculated. The CSA at 3 mm from the tip of new instruments of each brand was calculated. The correlation between the CSA and NCF was evaluated. All fractured surfaces were analyzed using a scanning electron microscope to determine the fracture mode.Results: The TF instruments were the most resistant to fatigue failure. The resistance to cyclic failure increased with decreasing CSA. All fractured surfaces showed the coexistence of ductile and brittle properties.Conclusion: The CSA had a significant effect on the fatigue resistance of NiTi rotary instruments.

Use of computerized tomography for diagnosis and follow-up after endodontic surgery: clinical case report with 8 years of follow-up

Mario Tanomaru-Filho, Regina K.P. Lima, Paula A. Nakazone, Juliane M.G. Tanomaru — 2010-04-01

Computerized tomography (CT) is a valuable tool for diagnosis and planning in conventional and surgical endodontic therapy. This case report describes the use of CT in the diagnosis of a periapical lesion undetected by periapical radiography in the mandibular molar area. The CT also showed a possible mesial root perforation associated with the lesion. Following CT, surgical planning, periradicular curettage, and sealing of the root perforation were performed. Eight years after surgery, cone beam CT revealed periapical bone repair. Computerized tomography can be an important resource for diagnosis and planning in conventional and surgical endodontic therapy, as well as for evaluation of post-treatment bone repair.

Endodontic photoactivated disinfection using a conventional light source: an in vitro and ex vivo study

Sebastian Schlafer, Michael Vaeth, Preben Hørsted-Bindslev, Ellen V.G. Frandsen — 2010-04-01

Objective: The antimicrobial effect of photoactivated disinfection (PAD) using toluidine blue and an LED lamp was tested on endodontic pathogens in planktonic suspension and after inoculation into extracted teeth. Irradiation time was limited to 30 seconds.Study design: The effect of PAD on planktonic suspensions of Escherichia coli, Candida albicans, Enterococcus faecalis, Fusobacterium nucleatum, and Streptococcus intermedius was analyzed using Poisson regression. Moreover, cultures of S. intermedius were inoculated into prepared root canals of extracted molars. The effect of PAD performed immediately after inoculation or after overnight bacterial incubation was determined by a 2-sample t test.Results: Photoactivated disinfection yielded significant reductions (P < .001) in the viable counts of all organisms in planktonic suspension. The PAD treatment of S. intermedius in root canals yielded a mean log10 reduction of 2.60 (P < .001) immediately after inoculation and of 1.38 (P < .001) after overnight incubation.Conclusion: Photoactivated disinfection using a conventional light source strongly reduces the number of viable endodontic pathogens in planktonic suspension and in root canals.

Analysis of heavy metal contents in gray and white MTA and 2 kinds of Portland cement: a preliminary study

2010-04-01

Objective: The levels of 10 heavy metals (arsenic, bismuth, cadmium, chromium, copper, iron, lead, manganese, nickel, and zinc) in gray Portland cement (GPC), white Portland cement (WPC), gray MTA (GMTA), and white MTA (WMTA) were analyzed by inductively coupled plasma-atomic emission spectrometry (ICP-AES).Study design: One gram of each material was digested with 80°C “aqua-regia” (7 mL of 60% HNO3 and 21 mL of 35% HCl), filtered, and analyzed by ICP-AES. The analysis was performed 6 times and the data were analyzed statistically.Results: Arsenic and lead concentrations were the highest in GPC (P < .05). GPC had much more of 7 heavy metals than the other 3 cements (P < .05). GMTA and WMTA had higher purity than GPC and WPC (P < .05), particularly when arsenic content was considered.Conclusion: If a clinician is considering using Portland cement versus MTA, the differences in purity may be considered.

Human pulp responses to in-office tooth bleaching

2010-04-01

Objective: To evaluate and compare the responses of human incisor and premolar pulps after bleaching.Study design: A bleaching agent with 38% hydrogen peroxide (H2O2) was applied on the buccal surface of 10 sound lower teeth (G1: 6 premolars; G2: 4 incisors) for 45 minutes. Three premolars and 3 incisors that received only rubber/pumice prophylaxis were used as control groups G3 and G4, respectively. Two days after the bleaching procedure, the teeth were extracted and processed for histologic evaluation.Results: Only in G2 (4 incisors) were any changes in the pulp detected. In the coronal pulp there was a large zone of coagulation necrosis. The radicular pulp showed mild inflammatory changes manifested as an accumulation of mononuclear cells around congested and dilated blood vessels. No pulpal damage was seen in either of the control groups (G3 and G4) or in group G1.Conclusion: Bleaching with 38% H2O2 for 45 minutes causes irreversible pulp damage in lower incisors but not in premolars.

Barodontalgia: what have we learned in the past decade?

Yehuda Zadik — 2010-04-01

This article reviews the current knowledge regarding barodontalgia, a barometric pressure–related oral (dental and other) pain. Contemporary classification, prevalence, and incidence, features, etiology, and diagnosis of this entity are presented regarding flight and diving conditions. Summarizing the past decade data, three-fourths of episodes were described as severe, sharp, and localized pain. Barodontalgia affects 11.9% of divers and 11.0% of military aircrews with a rate of 5 episodes/1,000 flight-years. Upper and lower dentitions were affected equally in flight, but more upper than lower dentition were affected in diving. The most prevalent etiologic pathologies for in-flight dental pain were faulty dental restorations (including dental barotrauma) and dental caries without pulp involvement (29.2%), necrotic pulp/periapical inflammation (27.8%), vital pulp pathology (13.9%), recent dental treatment (11.1%), and barosinusitis (9.7%). This review refutes 3 generally accepted conventions: According to the results, the current in-flight barodontalgia incidence is similar to the incidence in the first half of the 20th century, the weighted incidence of barodontalgia among aircrews are similar to the weighted incidence among divers, and the role of facial barotrauma in the etiology of in-flight barodontalgia is minor.

Transdentinal protective role of sodium ascorbate against the cytopathic effects of H2O2 released from bleaching agents

2010-04-01

Objectives: The objectives of this study were to evaluate the transdentinal cytotoxicity of 10% and 16% carbamide peroxide gel (CP), as well as the ability of the antioxidant, 10% sodium ascorbate (SA), to protect the odontoblasts in culture.Study design: Human dentin discs of 0.5-mm thickness were obtained and were placed into artificial pulp chambers. MDPC-23 odontoblastlike cells were seeded on pulp surface of the discs and the following groups were established: G1-No Treatment (control), G2-10% SA/6hs, G3-10%/CP6hs, G4-10%SA/6hs+10%CP/6hs, G5-16%CP/6hs, and G6-10%SA/6hs+16%CP/6hs. The cell viability was measured by the MTT assay.Results: In groups where 16% CP was used, decreased cell viability was observed. Conversely, the application of 10% SA on the dentin discs, before the use of the CP, reduced the cytotoxic effects of these products on cells.Conclusions: The 16% CP cause a significant decrease in MDPC-23 cell viability and 10% SA was able to partially prevent the toxic effects of CP.

Morphological assessment of dentine and cementum following apicectomy with Zekrya burs and Er:YAG laser associated with direct and indirect Nd:YAG laser irradiation

2010-04-01

Objectives: This study aimed to assess the apical surface morphology of maxillary central incisors resected 3.0 mm from the tooth apex using Zekrya burs or Er:YAG laser, with or without subsequent direct Nd:YAG laser irradiation (apical and buccal surfaces) and indirect irradiation (palatal surface).Study design: Forty maxillary central incisors were instrumented and obturated. The roots were divided into 4 groups according to the root resection method (Zekrya bur or Er:YAG laser – 1.8 W, 450 mJ, 4 Hz, 113 J/cm2) and further surface treatment (none or Nd:YAG laser – 2.0 W, 100 mJ, 20 Hz, 124 J/cm2). The teeth were prepared for SEM analysis. Scores ranging from 1 to 4 were attributed to cut quality and morphological changes. The data were analyzed by the Kruskal-Wallis test and by Dunn's test.Results: SEM images showed irregular surfaces on the apical portions resected with Zekrya burs, with smear layer and grooves in the resected dentine and slight gutta-percha displacement and plasticization. On the other hand, apicectomies carried out with Er:YAG laser showed morphological changes compatible with ablated dentine, with rough surfaces and craters. In spite of the presence of plasticized gutta-percha, with the presence of bubbles, an irregular adaptation of the filling material to the root walls was also observed. Direct Nd:YAG laser irradiation of the apical and buccal surfaces of the resected roots resulted in areas of resolidification and fusion in the dentine and cementum, with a vitrified aspect; indirect Nd:YAG laser irradiation of the palatal surfaces yielded a lower number of changes in the cementum, with irregular resolidification areas.Conclusions: There were no differences in terms of cut quality between the use of burs and Er:YAG laser or between the 2 surfaces (apical and buccal) treated with Nd:YAG laser with direct irradiation. However, morphological changes were significantly less frequent on surfaces submitted to indirect irradiation (palatal) when compared with those directly irradiated.

2010-04-01

Society Page

2010-04-01

Information for Readers

2010-04-01

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology

Editors

Translation of the Scientific Method … Peer Review

Oropharyngeal candidiasis in the era of antiretroviral therapy

Development of a novel bone grafting material using autogenous teeth

Comparison of the modified lateral orbitotomy approach and modified hemicoronal approach in the treatment of unstable malunions of zygomatic complex fractures

Functional endoscopic sinus surgery as an adjunctive treatment for closure of oroantral fistulae: a retrospective analysis

Resection and immediate reconstruction of a pediatric vascular malformation in the mandible: Case report

Effects of soft tissue punch size on the healing of peri-implant tissue in flapless implant surgery

Comparison of the osteoinductivity of bioimplants containing recombinant human bone morphogenetic proteins 2 (Infuse) and 7 (OP-1)

Clinical and radiographic outcomes of implants immediately placed in fresh extraction sockets

Effects of intra-articular administration of sodium hyaluronate on plasminogen activator system in temporomandibular joints with osteoarthritis

T−786C polymorphism of the endothelial nitric oxide synthase gene and neuralgia-inducing cavitational osteonecrosis of the jaws

Molecular methodology to assess the impact of cancer chemotherapy on the oral bacterial flora: a pilot study

Evaluation of penicillin G potassium troches in the treatment of minor recurrent aphthous ulceration in a Chinese cohort: a randomized, double-blinded, placebo and no-treatment–controlled, multicenter clinical trial

Neuropathic orofacial pain after dental implant placement: review of the literature and case report

Long-term treatment of Langerhans cell histiocytosis of the mandibular condyle with indomethacin

Cystic lymphoid hyperplasia of the parotid gland in HIV-positive and HIV-negative patients: quantitative immunopathology

Survivin as a potential early marker in the carcinogenesis of oral submucous fibrosis

Metastases in odontogenic cysts: literature review and case presentation

Oral metastasis of alveolar soft-part sarcoma: a case report and review of literature

Metastatic renal cell carcinoma to the oral cavity and clear cell mucoepidermoid carcinoma: comparative clinicopathologic and immunohistochemical study

A salivary gland adenocarcinoma mimicking a microcystic adnexal carcinoma

A case of primary combined neuroendocrine carcinoma with squamous cell carcinoma in the upper gingiva

Calcifying odontogenic cyst with odontogenic keratocyst: a case report and review of the literature

Prediction of dental implant torque with a fast and automatic finite element analysis: a pilot study

Density measurements of dentin by dual-energy radiography

Radiographic quantification of chronic dental infection and its relationship to the atherosclerotic process in the carotid arteries

Canine transmigration: comprehensive literature review and report of 4 new Australian cases

Carotid body paraganglioma manifesting as a malignant solitary mass on imaging: a case report

A comparison of nickel-titanium rotary instruments manufactured using different methods and cross-sectional areas: ability to resist cyclic fatigue

Use of computerized tomography for diagnosis and follow-up after endodontic surgery: clinical case report with 8 years of follow-up

Endodontic photoactivated disinfection using a conventional light source: an in vitro and ex vivo study

Analysis of heavy metal contents in gray and white MTA and 2 kinds of Portland cement: a preliminary study

Human pulp responses to in-office tooth bleaching

Barodontalgia: what have we learned in the past decade?

Transdentinal protective role of sodium ascorbate against the cytopathic effects of H2O2 released from bleaching agents

Morphological assessment of dentine and cementum following apicectomy with Zekrya burs and Er:YAG laser associated with direct and indirect Nd:YAG laser irradiation

Contents

Society Page

Information for Readers