Multiple oncocytic cysts with tyrosine-crystalloids in the parotid gland

A case of multiple oncocytic cysts with intraluminal tyrosine-rich crystalloids involving the parotid gland is described. The microscopic and ultrastructural findings are presented.

Full-arch restoration of the jaw with fixed ceramo-metal prosthesis: late implant placement

BACKGROUND

The completely edentulous patient has few treatment options in conventional dentistry. When implants are considered, treatment plans range from a 2-implant overdenture to a completely implant-supported prosthesis. Fixed prosthesis is often the preferred selection of the edentulous patient. This study assesses the 5-year cumulative survival rate of implants placed to support full-arch fixed restoration.

METHODS

During 1990 to 1995, 171 implants were placed in 22 completely edentulous jaws of 20 patients. All patients were discharged wearing immediate dentures. The implants were analyzed as to the number of implants per jaw, implant location, length, and diameter.

RESULTS

The 5-year cumulative survival rate was 89.9%. The mean number of implants per jaw was 7.7 for the maxilla and 8 for the mandible. In the maxilla, the preferred implant locations were the canines, centrals, laterals, and first premolars; in the mandible, they were the canines, laterals, and first molars. The mean implant length was 14.2 mm for the mandible and 13.2 mm for the maxilla. The mean implant diameter was 3.6 mm for the maxilla and 3.8 for the mandible.

CONCLUSIONS

The results of the present study indicate that fixed full-arch ceramo-metal restorations can be a predictable implant treatment modality for the edentulous patient.

Sinus floor augmentation with simultaneous implant placement in the severely atrophic maxilla

Dental implant placement associated with augmentation of the sinus floor in the severely atrophic maxilla can be performed in 1- or 2-surgical stages, depending on the height of the residual alveolar bone. A minimum of 4 to 5 mm of residual alveolar bone height is recommended for a 1-stage surgical procedure. The present study describes a 1-stage procedure in cases where the residual alveolar bone height in the posterior maxilla was 1 to 2 mm. A total of 55 hydroxyapatite-coated dental implants were inserted in 20 grafted sinuses of 20 patients. No case presented any difficulty in achieving initial stabilization and parallelism. No perforation of the sinus membrane or clinical complications of the sinuses were evident. Prior to exposure, radiographic evaluation revealed bone consolidation and a close bone-implant relation. At second-stage surgery, there was no clinical evidence of crestal bone loss around the implants. All implants were clinically osseointegrated. All patients received fixed implant-supported prosthesis. The mean follow-up was 26.4 months (range 15 to 39 months). There was no implant loss after loading. The following surgical modifications are essential: a wide lateral window opening, the use of a bone mill to homogenize the bone graft, meticulous condensation, and clinical measurements to ensure implant parallelism.

Full-arch restoration of the jaw with fixed ceramometal prosthesis

Between 1990 and 1995, 214 implants were placed in 29 maxillae and mandibles of 22 patients following extraction of all residual teeth as a consequence of severe periodontal disease. All patients were discharged wearing immediate dentures. The implants were analyzed with regard to the number per arch, location, length, and diameter. The 5-year cumulative survival rate was 98.5%. The mean number of implants per arch was 7.5 for the maxilla and 7.2 for the mandible. The preferred implant locations were canines, central incisors, lateral incisors, and second premolars in the maxilla; and lateral incisors, first molars, and canines in the mandible. The mean implant length was 14.7 mm in the mandible and 14.5 mm in the maxilla. The mean implant diameter was 3.8 mm in the maxilla and 3.8 mm in the mandible. The results of the present study indicate that immediate implantation for fixed full-arch reconstruction can be considered a viable treatment alternative in patients with severe periodontal disease.

The influence of the osteotomy slope on bony changes after advancement genioplasty

PURPOSE

The purpose of this study was to develop a prediction method for advancement genioplasty that would result in accurate preoperative cephalometric planning of the osteotomy slope and that could be transferred to the patient during the surgical procedure.

PATIENTS AND METHODS

Serial cephalometric tracings of 20 patients who underwent advancement genioplasty were retrospectively analyzed. The osteotomy slope angle was defined as the angle between the osteotomy and a line perpendicular to the occlusal plane. The measured angle was compared with the calculated angle deduced from the horizontal and vertical genial postoperative changes.

RESULTS

The measured osteotomy slope angle closely resembled the calculated angle.

CONCLUSIONS

The close similarity between the calculated and measured osteotomy slope angles in this study shows that simple mathematical calculations can be applied clinically to aid surgeons in achieving a more predictable result. The osteotomy slope can be determined early in the prediction stage as a calculated figure based on the desired horizontal and vertical movements of the chin and can be transferred to the patient's chin during the surgical stage.

Immediate implant placement: a procedure without incisions

Primary socket closure in immediate implantation may be difficult, due to the opening left by the extracted tooth. The absolute need for bone augmentation and primary flap closure for implants placed into fresh extraction sites has never been proven. The hypothesis of the present study was that immediate implants can succeed without primary flap closure. A technique that does not require any incisions during immediate implant placement is described. No barrier membranes were used and the sole grafting material used were autogenous bone chips. Full soft tissue coverage was achieved 1 week to 2 months postimplantation. Clinical osseointegration was achieved with minimal gingival recession and papillae preservation. Immediate implant placement in the anterior maxilla can be successful for replacing a single tooth even without primary closure.

Placement of implants into fresh extraction sites: 4 to 7 years retrospective evaluation of 95 immediate implants

A 7-year follow-up of implants placed immediately after tooth extraction into fresh extraction sites is reported. Small autogenous bone chips (from bone adjacent to implant sites) were grafted into the defect between the implant and the socket walls when needed. Closure of the wound was obtained by coronal repositioning of the flap, and no membranes were used. Care was taken to minimize hematoma formation under the flap during healing by part-time use of removable prosthesis with thick soft linings after implant surgery. At second stage surgery, mucoperiosteal flaps were apically repositioned for maximum attached gingival width and to reconstruct the vestibule. Minor complications such as exposure occurred in 16% of cases. Implant mean 5-year cumulative survival rate was 95%. There was no implant loss after loading. The results indicated that implants placed into fresh extraction sites grafted with autogenous bone chips will heal predictably.

The ways and wherefores of immediate placement of implants into fresh extraction sites: a literature review

A waiting period of 12 months or longer to allow total socket healing used to be accepted protocol for placing dental implants. More than 15 years of research and clinical practice were needed for the concept of immediate endossceous implantation into fresh extraction sites to be accepted. Today the dilemma is no longer when, but which, protocol to follow. The diverse recommendations found in the literature leave the practitioner confused as to the methodology of choice. The conclusions drawn after reviewing the relevant literature on immediate dental implantation are: 1) implants placed into fresh extraction sockets have a high rate of survival, ranging between 93.9% to 100%; 2) implants must be placed 3 to 5 mm beyond the apex in order to gain a maximal degree of stability; 3) implants should be placed as close as possible to the alveolar crest level (0 to 3 mm); 4) there is no consensus regarding the need for gap filling and the best grafting material; 5) the use of membrane does not imply better results-on the contrary, membrane exposure may carry complications in its wake; and 6) the absolute need for primary closure remains to be established.

Vigabatrin-induced gingival overgrowth

Vigabatrin is a relatively new medication used in the treatment of epilepsia. The present report concerns the use of vigabatrin by a 19-year-old woman. The patient manifested marked gingival overgrowth compatible clinically and histologically with the overgrowth induced by phenytoin, cyclosporine and calcium channel blockers. This is the 1st report of vigabatrin-induced gingival overgrowth. Clinicians should be aware of similar lesions in patients using new anticonvulsants.

Salivary immunoglobulins in recipients of bone marrow grafts. III. A longitudinal follow-up of CMV specific antibodies

Cytomegalovirus (CMV) infection is a major complication of BMT. The oral cavity is a common route for CMV infection, whose protection is provided by salivary anti-CMV antibodies. We developed an ELISA assay for the detection of CMV-specific antibodies in parotid saliva. Saliva of patients receiving BMT from CMV-positive donors was transiently reconstituted with IgG and IgA anti-CMV antibodies shortly after transplantation. The concentration of these antibodies gradually decreased during the 2 months after transplantation and increased again around day 80. A remarkable rise in the salivary concentrations of IgG and IgM anti-CMV was observed shortly after i.v. administration of Sandoglobulin. These results demonstrate, for the first time accurate monitoring of CMV-specific antibodies in saliva using a quantitative ELISA assay. The study suggests that secretion of CMV-specific antibodies in saliva of immunocompromised patients can be reconstituted by donor-derived B and plasma cells transferred with the BM or by i.v. administration of pooled Ig.

A longitudinal follow-up of salivary secretion in bone marrow transplant patients

Salivary gland dysfunction is a common sequela of the bone marrow transplantation procedure. We determined the effect of different bone marrow transplantation protocols on parotid salivary flow rate. Salivary secretion was substantially reduced during conditioning of all the recipients. A gradual flow rate reconstitution could be detected as soon as a few days after the bone marrow transplantation. Eight patients conditioned with total lymph node irradiation and chemotherapy or chemotherapy alone displayed earlier and complete recovery of saliva secretions 2 to 5 months after the grafting. Recovery was delayed and incomplete when total body irradiation was added to the conditioning regimen (seven patients). Six of these patients also developed graft-versus-host disease. The results suggest that total body irradiation induces irreversible damage to the parotid glands resulting in profound xerostomia followed by opportunistic infections. Chemotherapy with or without total lymph node irradiation does not induce such damage.

Salivary immunoglobulins in recipients of bone marrow grafts. I. A longitudinal follow-up

Patients receiving bone marrow transplantation (BMT) are prone to a variety of bacterial, viral and fungal infections in their oral cavity. We have therefore followed alterations in salivary Ig levels associated with BMT. Most of the patients were transplanted with allogeneic, MHC-matched BM after T cells were depleted by ex vivo treatment with an anti-lymphocytic monoclonal antibody (Campath-1) and autologous complement. Parotid saliva was collected at various time intervals before and after BMT, and IgM, IgG and IgA concentrations were determined by an enzyme linked immunosorbent assay (ELISA). A gradual fall in Ig levels was detected following patient's conditioning with a combination of chemo- and radiation therapy beginning 10 days prior to BMT. A rise in the titer of salivary Ig could be detected as early as 4 days post-BMT, which increased continuously and reached plateau levels within 2-3 weeks. However, about 3 weeks later the Ig titers decreased again and persisted at low levels for variable periods of time. A second increase in salivary Ig was detected approximately 2 months post-BMT, which persisted for prolonged periods of time. These results suggest that Ig secreted by donor B-lymphocytes and plasma cells passively transferred with the BM can rapidly reconstitute the salivary IgM, IgG and IgA of the immunocompromised recipient. However, when these cells cease to produce Ig the patients are still immunoincompetent and therefore enter a second phase of salivary Ig deficiency which may render them highly susceptible to opportunistic oral infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Salivary immunoglobulins in recipients of bone marrow grafts. II. Transient secretion of donor-derived salivary IgA following transplantation of T cell-depleted bone marrow

Patients undergoing bone marrow transplantation (BMT) have decreased levels of salivary Ig over long periods of time. However, shortly after transplantation, a transient rise of Ig concentration in their saliva gland is detected. In order to trace the origin of this Ig, seven BM donors were immunized with tetanus toxoid (TT) 4-7 days prior to BMT harvesting. Four patients received BM from non-immunized donors. All but one of the patients had no detectable anti-TT IgA in their parotid saliva prior to BMT. Recipients of T cell-depleted BM from pre-immunized donors transiently displayed high titers of salivary anti-TT IgA 7-28 days after transplantation. No significant anti-TT IgA titers were detected in saliva of patients grafted with non-immunized BM. We conclude that antibody-producing cells activated in the donor are passively transferred with the BM to the recipient. IgA committed cells home to the mucosa-associated lymphoid tissues (MALT) and continue to secrete antibodies until senescence.