Histological changes in odontogenic parakeratinized keratocysts treated with marsupialization followed by enucleation

Background

The purpose of this study was to evaluate whether marsupialization treatment induces changes in the histology of odontogenic keratocyst epithelium and to compare our experience with the literature.

Material and Methods

A retrospective revision of histological samples was performed. 5 patients with odontogenic keratocyst treated with marsupialization follow by enucleation were selected. Histologic evaluation analyzed the changes in the keratocyst epithelium after marsupialization in terms of type of keratinization, thickness of the epithelium and connective tissue, the presence of acanthosis, the presence and grade of fibrosis, the type and grade of inflammation and the presence and number of mitotic figures and daughter cysts.

Results

In our case series, a variation of para-keratinized into ortho-keratinized keratocyst was found in one case, and no significant increases were observed in the epithelium and capsule thickness, or even in the level of inflammation. However, we observed an increase in fibrosis and qualitative changes in inflammation type.

Conclusions

Minor and major histological changes were associated with reduction in cyst volume, which resulted in a simpler and less invasive cystic enucleation after marsupialization.

Key words:Keratocyst, marsupialization, enucleation, histology, histological changes.

Professional clinical bleaching with Pola Office: 6-month clinical results with spectrophotometric analysis

AIM

The aim of the study was to evaluate the efficacy of the professional bleaching treatment with Pola Office (SDI): the shade, chroma and value parameters of the anterior upper elements were analysed.

METHODS

At the Prosthetic Unit of the Modena and Reggio Emilia University, 10 patients were selected. All patients underwent oral hygiene treatment and spectrophotometric analysis (Spectro-Shade) of the 6 front elements: the variables L (value), c (chroma), and h (shade) were examined in the cervical, mesial and incisal sections. Spectrophotometric analysis was repeated 6 months after initial bleaching. The patients were asked to report the degree of sensitivity after 3, 6, 12 and 24 h and after 3, 6, 7, and 10 days.

RESULTS

The value (L) of the treated elements increases after bleaching, the chroma parameter (c) showed lower values than those prior to treatment (except for the first patient); this means a shift towards a lower degree of saturation. The course of the shade parameter is uniform and constant for all patients, with a shift towards yellow chroma values. Postoperative sensitivity was confined to the first 3 h after treatment, after which it showed a steady decrease over 24 h.

CONCLUSIONS

Esthetic results obtained using the Pola Office bleaching procedure were visibly significant; confirmed by colorimeter analysis. The harmony between chroma, shade and value remained 6 months after the bleaching treatment; the sensitivity is particularly high in the first hour, however after 24 h sensitivity is greatly reduced.

Augmentation of keratinized gingiva through bilaminar connective tissue grafts: a comparison between two techniques

AIM

A mucogingival deficiency is considered a potential risk factor for periodontal disease. In particular, mucogingival deficiency can lead to gingival recession, which is a pathological entity per se, due to the increased risk for dental hypersensitivity and root caries. The aim of this study was to evaluate and compare 2 bilaminar grafting techniques normally employed to achieve root coverage.

METHODS

Thirty-five patients were divided into 2 groups. Group 1 included 19 patients with 49 gingival recessions treated by Nelson technique (as modified by Harris), while group 2 included 15 patients with 40 recessions treated by Langer technique. Clinical evaluation was performed at preoperative level (T0), after 1 month (T1) and after 1 year (T2). Statistical analysis was performed by means of Friedmann and Wilcoxon test and U-Mann-Whitney test.

RESULTS

The statistical analysis did not reveal any significant difference between groups, both in terms of percentage of root coverage and of width of keratinizaed gingiva gain. A significant difference was only observed within each group, for the amount of keratinized gingiva at T1 vs T0 and at T2 vs T1.

CONCLUSIONS

This study did not show any statistical difference between the Nelson and the Langer technique as to root coverage and gain in keratinized gingiva.

Ectopic localization of Carabelli's tubercle. Review of the literature and description of two clinical cases

The aim of this study is to describe 2 ectopic localizations of Carabelli's tubercle. Carabelli's tubercle or cusp is present, in a fair number of cases, in the vestibular walls of both first upper molars. Its size may vary. It is named after the Italian scientist Antonio Carabelli who first had described it in the first half of the 19(th) century. Carabelli's cusp has been often detected and studied in not hybridized ethnical groups, especially Eastern and Central Ameri-can groups, in which the evaluation of heritability and sex distribution is easier. It has been found that this cusp is not clinically important, it may only sometimes interfere with orthodontic treatments. It is seldom present in the second upper molars and almost never in the vestibular walls of either side of the second upper or lower molars. After a review of the literature showing that this cusp is more rarely present in Caucasian peoples, the authors describe 2 case reports with ectopic localization. This has never been found in recent literature and therefore it is to be considered absolutely rare.

Release of elements from retrieved maxillofacial plates and screws

Vitallium appliances and surrounding tissues were investigated to evaluate the release and accumulation of elements. Four microplates, sixteen screws and surrounding tissues were removed from three patients presenting inflammation 4 to 6 years after surgery and were submitted to SEM and X-ray microprobe analysis. Histology was performed on paraffin or PMMA sections of tissues.A continuous release of elements from metallic appliances into soft tissues was observed. Cobalt, chromium, and nickel were detected in soft and boney tissues in close proximity to the appliance. Aluminium, as a component of screw coatings, accumulated in soft tissues, and a remarkable amount of aluminium was detected in the dense lamella of lamellar bone. The results suggest that coatings containing aluminium should be avoided and the time these appliances are allowed to remain in patients should be shortened. Further studies on element release and the fate of aluminium in bone are warranted.

[Teeth and oral mucosa in neurocutaneous syndromes, metabolic diseases and in diseases with defects of DNA repair]

Oral mucosa is frequently involved in a group of genetic diseases, which affect the skin and other organs, particularly the central nervous system. The lesions may be of characterized by inflammations in neurocutaneous syndromes and by tumoral lesions in those diseases with defects of DNA repair. The teeth are mainly involved in progeria, while jaw keratocysts are highly characteristic in Gorlin's syndrome.

[Tooth disorders in ectodermal dysplasias]

Recently, the molecular bases of the most frequent ectodermal dysplasias have been identified; they involve genes responsible for the epithelial morphogenesis, and the regulation of cell survival and proliferation. Teeth alterations with characteristic features are often observed in X-linked anhidrotic ectodermic dysplasia and in autosomic recessive anhidrotic ectoderma, rarely in hidrotic ectodermal dysplasia.

[Tooth and oral mucosa hereditary anomalies in complex syndromes characterized by hyper- or hypotrichosis]

A wide range of hereditary anomalies, characterized by hair defects and only partially known from the genetics point of view, involves the teeth and oral mucosa with particular features. Teeth alterations are extremely heterogeneous; very frequently gums, palate, tongue and lips are affected. Waiting for a more comprehensive genetic definition and classification, these anomalies are grouped according to the hair defect (hypotrichosis, hypertrichosis and mixed-type).

[Metallic elements in tissues surrounding internal rigid fixation (IRF) devices]

BACKGROUND

Plates and other devices made by several alloys have been introduced to reach the stability of bone fractured fragments. Elements constituting alloys could be detected especially in organs, yet also in local tissues. Aim of the present study is the analysis of tissues surrounding IRF devices analyzing the morphology of released particles and studying the behavior of adjacent tissues to check metallic elements diffusion.

METHODS

Biopsies were retrieved from 18 patients, aged 20 to 76 years. The patients received IRF by plates, screws and grids from 4 months to 9 years. They were divided into five groups according to the local phlogistic degree. Ordinary light microscopy, scanning electron microscopy and X-ray microprobe analysis (EDS system) was used to perform morphological investigations and identification of metal particles and elements.

RESULTS

Metal particles or elements arising from plates, screws or grid may undergo tissular diffusion and cellular uptake. Not only Chromium, Iron or Aluminium but also Titanium may be easily released from devices and engulfed in tissues. In particular Titanium diffusion is evident in fibrous tissue surrounding IRF devices. Aluminium appears to be particularly accumulated in a persistent way in fibrous tissues and shows a characteristic embedding pattern in lamellar bone.

CONCLUSIONS

The degree of local phlogosis appears to be strictly correlated to metallosis. Chromium, Iron, Aluminium and also Titanium, even if at different degree, give rise to phlogistic effects. Metallosis and phlogosis can produce a cascade process in which they are both the cause and the effect at the same time. The abundant release of Titanium, which does not normally produce clinical phlogosis as i.e. Aluminium, should be worthy of further investigations on its cellular effects.

Associated orthodontic, surgical and hematological management of Cooley s anemia. Report of a case

Cooley s anaemia or b-thalassaemia or mediterranean anaemia is a blood disease characterised by malformation of the skull and long bones, which confers a typical appearance on the patient. The complete development of facial abnormalities can be prevented by an intensive blood transfusion programme or by bone-marrow-transplantation. At the present time these therapeutic strategies would be able to help these patients grow and develop, live a prolonged life and avoid bad surgical RESULTS. The aim of this study was to evaluate the feasibility of orthodontic and maxillofacial surgical corrective treatment associated with an appropriate transfusion therapy in a b-thalassemic patient. The patient enrolled in the study was affected by major b-thalassemia and diagnosis was performed as an infant. She was referred to our centre at puberty for dento-maxillofacial disorders. Clinical, haematological and radiographic evaluation permitted a complete diagnosis. She received a combined haematological, orthodontic and maxillofacial surgical treatment. Controls for evaluating the statement of results obtained were performed at different times after the end of the therapy and have shown that the therapeutic objectives had been achieved and maintained. At the present time, complete diagnostic and therapeutic haematological strategies cannot be carried out on a large scale, especially in countries where health resources are limited. This objective reason, associated with possible low patient compliance, explains why we still encounter severe facial deformities resulting from erythroid hyperplasia. Our results suggest that this facial disfigurement requires surgical and orthodontic correction by consolidated surgical-orthodontic techniques performed according to the appropriate anaemia therapy. Although this is a preliminary study, initial encouraging results show no relapse three years after the end of the therapy.

Intracranial spread of a giant frontal mucocele: case report

A giant mucocele eroded both the anterior and posterior wall of the frontal sinus and infiltrated the dura mater. Its extracranial growth caused a frontal bony prominence. The tumour and part of the dura were resected. A 12 x 6cm defect in the dura was repaired with a freeze-dried patch. A split-thickness bone graft from the right parietal region was used to repair the anterior frontal bony defect. The result one year later was satisfactory. Spiral computed tomography with thr ee-dimensional reconstructions excluded any recurrence of the tumour and showed good integration of bone grafts.

[Clinical evaluation, radiologic and histologic analysis in mandibular alveolar distraction procedures. Preliminary study]

BACKGROUND

Alveolar distraction osteogenesis is a process to form new alveolar bone to correct alveolar deformities in ridge height and width. Aim of this work is to study the bone processes to optimize the implantoprosthetic rehabilitation.

METHODS

Alveolar distraction osteogenesis was applied in 7 patients with ridge deformities to obtain the desired ridge augmentation. Clinical and radiological evaluations were performed during the following 12 weeks, before implant insertion. Biopsies at 40, 60 and 88 days were studied after general, specific and histochemical staining of slides; microradiographs were analyzed to evaluate the trabecular bone volume.

RESULTS

Forty days after the end of distraction, soft callus shows the start of ossification. Sixty days after the end of distraction, soft callus was widely converted into a network of trabecular woven bone; osteogenic activities were low; trabecular bone volume was about 50%. Eighty-eight days after the end of distraction bone amount appeared reduced, with a more ordered structure, further reduction of bone formation activity, whereas osteoclast erosion was active.

CONCLUSIONS

Results show an almost steady-state bone deposition processes 60 days after the end of distraction and a regress with longer time. The results suggest the possibility of an early implant insertion to avoid bone loss due to mechanical unloading.

[In vitro study of periodontal ligament cells]

BACKGROUND

The aim of this research is to outline a procedure able to promote specific cellular differentiation and proliferation with consequent periodontal regeneration. To achieve this goal, use was made of various compounds supposed to have the capacity of aiding periodontal regeneration.

METHODS

The cells utilised for this study were obtained from explants of human periodontal ligaments. Their proliferation and differentiation capacity was examined in the presence of: coral granules (350, 500 mu), collagene type 1, growth factors (Platelet derived growth factor, PDGF and Transforming growth factor beta 1, TGF beta 1), both on their own and in different combination with one another. The differentiation activity was evaluated by ultrastructural morphological method (Transmission electron microscope-TEM) and by spectrophotometric investigation of the alkaline phosphatasis (ALP).

RESULTS

The data show that the coral granules and among the growth factors used only TGF beta 1 stimulate the differentiation activity of the periodontal ligament cells valued on the basis of their capacity of producing ALP. These data are supported by the observation with TEM.

CONCLUSIONS

From these results it is suggested that there may be therapeutic efficiency in the periodontal field of substances promoting cellular proliferation and differentiation.

Distraction osteogenesis to achieve mandibular vertical bone regeneration: a case report

In this case report a surgical technique for vertical ridge augmentation is presented. The procedure, performed in a 30-year-old woman with an atrophied alveolar ridge in the anterior portion of the mandible, is based on the biologic concept of osteogenesis distraction previously introduced in orthopedic and maxillofacial surgery. After elevation of a full-thickness flap a horizontal osteotomy was performed 7 to 8 mm from the top of the ridge. Two vertical osteotomies were prepared with drills of increasing diameter (2, 2.8, and 3.25 mm), tapping was performed for the first 5 to 6 mm, and two distractor base plugs were placed at the base of the osteotomies with a repositioning tool. An intraosseous distraction implant was then inserted and 2 inward vertical cuts were made in the bone to allow proper distraction to take place. Correct functioning of the device was checked by distracting the bone fragment 1 mm using the axial distraction screw. A latency distraction healing screw was inserted in each of the distraction implants and the area was left to heal for 5 days. Once primary healing had occurred, the distraction of the newly formed bone callus was activated each day for 10 days (1 mm per day). At the end of the distraction period a final distraction screw was left in place and a final healing screw was inserted. During this time there were no complications and the patient on no occasion complained of discomfort. The distractor device was removed 30 days later, leaving the base plugs in place. One month later a vertical augmentation of 7 mm had been achieved; the base plugs were removed, 3 intraosseous implants were inserted, and a biopsy of the newly formed tissue was obtained. Histologic evaluation of the biopsy specimen showed woven bone formation approximately 75 days after the initial procedure.

Early diagnosis of nevoid basal cell carcinoma syndrome

BACKGROUND

Nevoid basal cell carcinoma syndrome, or NBCCS, is a hereditary condition characterized by basal cell carcinomas, or BCCs; odontogenic keratocysts, or OKCs; and skeletal abnormalities. The authors conducted this study to determine the early signs of NBCCS.

METHODS

The authors reviewed files from two Italian dental schools from January 1980 to January 1995 to determine the early signs of NBCCS and the age at which patients were first examined. They re-examined all of the patients, using the diagnostic criteria for NBCCS.

RESULTS

The authors found 14 patients who fulfilled the criteria for diagnosis of NBCCS in five families. All of the patients were 16 years of age or younger. In 11 cases (78 percent), the first sign of NBCCS in the patients was an OKC. The OKCs diagnosed in patients older than 13 years of age were large and characterized by widespread bone resorption. One 11-year-old patient had six large OKCs. The authors also found a case of multiple OKCs in an 8-year-old patient. Only one patient showed BCCs.

CONCLUSIONS

OKCs are often the first signs of NBCCS and can be detected in patients younger than 10 years of age. Our data suggest that OKCs arise earlier in patients who have NBCCS than in patients who do not have NBCCS. The patients' young ages explain the low incidence of BCCs in this study.

CLINICAL IMPLICATIONS

The presence of multiple OKCs in a child or onset of BCC in a patient younger than 20 years of age should alert dentists to the possibility of the patient's having NBCCS.

Nevoid basal cell carcinoma syndrome. Clinical findings in 37 Italian affected individuals

Nevoid basal cell carcinoma syndrome (NBCCS) is a hereditary condition transmitted as an autosomal dominant trait with complete penetrance and variable expressivity. The syndrome is characterised by numerous basal cell carcinomas (BCCs), odontogenic keratocysts of the jaws, palmar and/or plantar pits, skeletal abnormalities and intracranial calcifications. In this paper, the clinical features of 37 Italian patients are reviewed. Jaw cysts and calcification of falx cerebri were the most frequently observed anomalies, followed by BCCs and palmar/plantar pits. Similar to the case of African Americans, the relatively low frequency of BCCs in the Italian population is probably due to protective skin pigmentation. A future search based on mutation screening might establish a possible genotype phenotype correlation in Italian patients.

Computed tomography and magnetic resonance imaging in the management of coronoid process hyperplasia: review of five cases

OBJECTIVE

To describe the imaging features of primary bilateral coronoid hyperplasia, with particular reference to the use of CT and MRI.

MATERIALS

A series of five cases is reviewed.

RESULTS

The correct diagnosis was achieved with panoramic radiography alone or with the addition of CT. MRI did not provide additional pre-operative information; it was useful in the postoperative assessment of poor functional recovery in order to determine the presence of haematoma and/or fibrosis.

CONCLUSIONS

Although panoramic radiography alone can demonstrate this condition, CT has an important role in diagnosis and is useful for an adequate surgical planning by allowing assessment of the size of impingement of the coronoid processes. MRI is useful for evaluating postoperative complications involving soft tissue.

[Brodie's syndrome. A report of 2 atypical cases]

The aim of the authors is to show the treatment of Brodie's syndrome even in atypical cases where this pathology can not offer typical signs but can be associated to other skeletal deformities of the face. There are two atypical cases of Brodie's syndrome both of them came to our out patient's department. They were grown-up (one 20 one 22 years old), one of them with an extreme vertical expansion of lower third of the face and with a big transverse expansion of the upper maxillary bone, all typical signs of Brodie's syndrome; the other patient was with an extreme transverse expansion of the upper maxilla associated to a II class and a defect of 11, 12, 21, 22. The first patient was treated with orthodontic Tweed technique continued with surgical operation setting out to the contraction of the transverse diameter of the upper maxilla, associated to a Le Fort I osteotomy and an Epker osteotomy of the jaw. This orthodontic-surgical correction, allowed us to achieve a good aesthetic and functional result. The second patient was treated with orthodontics followed by surgical correction of the excessive transverse expansion of the upper maxilla after a Le Fort I osteotomy; a sagittal split of the jaw on Gotte technique was performed to correct the III class. We gave the patient a good aesthetic result with the restoration of the lost teeth in the upper maxilla, reaching in this way a good aesthetic and a well functioning result. We think it's possible to treat patients with atypical Brodie's syndrome with orthodontics or surgery in the same way we treat Brodie's syndrome and other deformities of the face reaching good aesthetic-functional results.

[In vivo and in vitro experimentation with the effects of chlorhexidine in patients who have undergone a periodontal intervention]

The periodontal pack is often used to cover the surgical site after surgery, even when associated with local applications of preparations containing chlorexidine, in order to obtain an antiseptic protection. However many people question whether the drug effectively succeeds in penetrating the pack, or if the presence of the pack itself doesn't obstruct the action of the medication. The aim of this work is to evaluate the efficiency of the clorexidine in the surgical area with and without a periodontal pack. In a first stage, a case was chosen and contemporary operated on in two different but anatomically similar sites at the same time. One of the two sites was covered with a chlorexidine gel for the following week, whilst the other was left without medication. After seven days the stitches removed from the two different sites were placed in culture mediums to number and classify the bacterial strains present. In the second stage of the experiment, another eight patients were operated on in the same way, and the two sites covered with periodontal packs. In one of the two sites a layer of chlorexidine gel was positioned under the pack, and the chlorexidine above and on the sides of the pack was continually renewed throughout the week following the operation. The other site was not treated. The results obtained show that the pack partially reduces the action of the drug medication, probably because an insufficient amount reaches the site. The activity and efficiency of chlorexidine against the strains of bacteria found in vivo were tested in vitro. The chlorexidine destroyed all of them.(ABSTRACT TRUNCATED AT 250 WORDS)

Chondroblastoma of the temporal bone. Case report

A case of chondroblastoma of the temporal bone in a 53-year-old male patient is presented. The diagnostic and therapeutic processes are discussed.

[Dens invaginatus. Review of the literature and presentation of two clinical cases]

Authors present two cases of dens invaginatus, radicular variety in lateral incisors teeth. They suggest a revision of literature, underlining epidemiological, classifying, clinical and terapeutical aspects of this pathology.

[Microcystic adnexal carcinoma. A case report]

Microcystic adnexal carcinoma (MAC) is a rare cutaneous neoplasm, locally aggressive, recently recognized as a clinicopathologic entity. Histologically, MAC shows both ductal and pilar differentiation. In this article we discuss a case of 52-year-old woman with MAC on the inferior lip, early recurred after initial excision.

[Odontogenic sinusitis. An evaluation and the radiologic checkup protocol after a Caldwell-Luc intervention]

A homogeneous group of 30 patients who were operated over a 5-year period for odontogenic sinusitis using a buccosinusal communication following Caldwell-Luc's technique were studied. A marked discrepancy between the conventional X-ray picture and the clinical picture emerged from these 30 case studies. So as to find an explanation for this discrepancy, all patients underwent CAT tests. On the basis of a critical evaluation of the results obtained it is suggested that patients be followed using a postoperative instrumental control protocol.

[Samples of iliac crest bone. A case report review and clinico-statistical evaluation]

The paper examines 91 cases of iliac crest bone samples used in maxillofacial surgery for different purposes and evaluates the immediate and later complications which arise in the site of origin. The most frequent immediate complications are walking difficulties, hematoma, and sensitivity disturbances. Later complications usually include: esthetic deficits (depression of the crestal surface), walking difficulties, and a persistent neurological deficit. The complications observed substantially match those reported in the literature.

Pharmacokinetics and human tissue penetration of flurithromycin

The relationship between concentrations in serum and levels in tissue of flurithromycin, a new fluorinated macrolide, was determined in patients undergoing maxillofacial surgery and thoracotomy. All patients received 500 mg of flurithromycin orally every 8 h. Drug levels in serum, bone, soft tissue, lung, and pericardial fluid were determined microbiologically. The total amount of antibiotic per gram of tissue was calculated on the basis of the concentration in the supernatant of the homogenate. From the parallel course between free concentrations in serum and calculated contents in interstitial fluid tissue, it was concluded that the tissues examined were easily accessible by flurithromycin; penetration values measured by the ratio of areas under the curve were 8.3 for lung, 3.6 for bone, and 0.8 for soft tissue. The results of the pharmacokinetic study suggest that accumulation of the drug during repetitive multiple doses is predictable. Mean residence times were 10.2 and 8.3 h in groups 1 and 2, respectively. For bacteriostatic drugs such as macrolides, not only very high but also prolonged concentrations in tissue lead to favorable therapeutic result.